What is direct primary care?
What is direct primary care?
The direct primary care model is essentially a payment model where, for a defined set of primary care services, a family physician is paid periodically rather than in a fee-for-service insurance billing. This periodic payment can be monthly, quarterly or yearly, depending on the agreement between the family and the doctor. This model can be used anywhere where there’s a direct contract between patients and medical health professionals as a replacement for the traditional third-party insurance coverage.
The primary care services this periodic fee covers will include all clinical and lab costs, consultative services, comprehensive care management and coordination. However, most direct primary care models do not account for emergencies, so they tend to be exclusive of such costs.
How Does Direct Primary Care Work?
Direct primary care has only grown in popularity after it started in the mid-2000s, largely due to the increasing confusion regarding health insurance, which was not only confusing but also quite expensive. Patients who didn’t have health insurance or those who were sick of spending so much on it saw direct primary care as the way to afford basic healthcare.
Since this is a direct contract between patient and doctor, there are no insurance providers involved in the process. So instead of paying monthly health insurance premiums, patients choose to pay monthly fees directly to their doctor in exchange for basic primary healthcare.
However, like any model, the DPC also has its pros and cons, and if you’re thinking about opting for this model, it may be well worth your time to take a look at the following benefits and drawbacks of direct primary care.
Benefits of Direct Primary Care
Enduring Doctor-Patient Relationships
One of the hallmarks of the DPC model is the enduring relationships between patients and doctors. Compared to an average fee-for-service primary care practice, a direct primary care practice has much fewer patients to see per day.
Since doctors have much fewer patients to deal with, they can give each of their patients more time and energy and therefore develop more lasting relationships with them. They tend to know their patients by name since they see around 10 patients in a day as opposed to 30. So much of the patient interaction is electronic now, which makes it even easier on the doctors and leads to less burnout.
As a result of DPC doctors having more time on their hands, patients end up receiving better care, which leaves both parties satisfied.
DPC Offers Upfront Pricing
Direct primary care practices offer transparent, upfront pricing, with a monthly payable amount that covers unlimited visits to the clinic for primary care services. To be prepared for emergencies, patients are urged to buy complementary health insurance plans but most DPC physicians tend not to accept insurance.
Convenience and Accessibility
Direct primary care patients usually have access to next-day and even same-day visits with 30–60-minute appointments. On top of that, patients have the option to call, text, email or even video chat with their physician any time during the day, thereby making the waiting room obsolete. In other words, patients have full access to a healthcare professional at all times, all just for the monthly fee they pay.
This full-time accessibility is not offered by regular doctors mostly because it’s difficult to bill phone calls or other such means of getting consultations.
Direct primary care physicians will usually have a large circle of highly qualified physicians and experienced specialists who can be accessed easily if such a need arises. So it takes away that worry too, of whether or not you’ll be able to see a specialist in time if you need more than primary care.
Patients can get consultations from specialists in a matter of days and sometimes even same-day consultations can be made. It saves you the hassle of finding and making appointments with other doctors. But in-person visits with specialists will cost above what you pay in the monthly fee.
Disadvantages of Direct Primary Care
You Will Still Need an Insurance Plan
While primary care consultations are all covered by the monthly amount you pay, emergencies remain unaccounted for. This means your need for insurance still exists. Any additional testing, procedures, medications will require you to pay in addition to the monthly payment you make.
This means that you will need some sort of an insurance plan along with your DPC.
DPC Membership Doesn’t Count Toward a Deductible
Currently, the direct primary care monthly membership fee is recognized as a “health plan” by the IRS. Therefore, it’s not eligible to be considered a deductible which means you will have to pay for it out of your pocket if you carry high deductibles in health insurance as well.
Is Direct Primary Care Worth It?
For families with young children or elderly patients, getting in touch with a physician on an urgent basis is a huge plus. Since direct primary care allows for 24/7 phone calls, texts, emails and the like, it will be the understandable choice for such families. People who travel frequently will also appreciate the quickness of consultation that the DPC model provides.
On the flip side, however, because direct primary care memberships are usually exclusive of insurance, they may not be a good choice for people who require more than just primary care every month. So, people who have complex medical issues may not prefer DPC. DPC is best for patients who are generally in good health, and only need visits to the doctor for general upkeep and routine checkups.
So if you are generally in good health and you want to cut down on costs associated with physicals, lab tests and other routine visits, looking into DPC may be a financially wise decision.
If you are looking for a Direct Primary Care Membership, visit us and learn more about how it will work for you.
Dr. Josh is a physician who's helping spread the knowledge about Telehealth and its advantages. At SmartClinix, he's providing his expertise and knowledge in the form of engaging articles on various health & tech related topics.