Typically, when the subject of Direct Primary Care is brought up, people invariably respond with “I know all about this. It is concierge care”. They could not be more wrong. Concierge care involves health insurance. Patients pay a fee in addition to their insurance for enhanced access to their doctor. There are still co-pays, deductibles, and other pitfalls about health insurance. Direct Primary Care (DPC) is an arrangement between patients and doctors where they pay a modest fee ranging from $40- 120 per month. No insurance is involved. The doctor can usually provide a wide range of services for this fee in the office, and there are no additional charges.
DPC is the fastest-growing healthcare delivery model in the country except for hospital employment, with over 7,000 such practices across the USA. Critics constantly attempt to poke holes in this model, raising concerns about what happens if a patient needs tests that the DPC doctor cannot perform in the office, needs surgery, or develops a serious illness such as cancer.
A doctor in a DPC practice usually limits the number of patients to 700-800 rather than the 2500 that a primary care doctor typically manages. This means a patient can see their doctor when they need to, and the doctor can spend as much time with them as needed. It is better care for patients. The knock against doctors in these practices is that they only want healthy patients. It is just the opposite. Sick patients get better-individualized care.
Most DPC doctors have worked out arrangements with independent labs and imaging centers in their communities so that if a patient needs tests, they could pay for them directly, but for a fraction of what it would cost as a co-pay using their insurance. Blood tests can cost a patient less than $10, and CT scans just $150. If it seems too good to be true, it’s not. This is happening right now with thousands of patients across the country.
Patients needing surgery can usually be referred to specialists who have agreed to work with DPC practices and charge a significantly lower fee for cash. Patients concerned about catastrophic events can purchase supplemental major medical policies or participate in healthcare cooperatives or healthcare-sharing ministries.
The savings for patients is significant. A family of 4 that has to purchase a typical Silver plan on one of the ACA exchanges has to pay $24,000 in premiums if they do not receive subsidies and have additional exposure of up to $16,000 in deductibles. This means $40,000 is paid out of pocket before insurance pays anything. By contrast, if that family had a DPC doctor and purchased a supplemental insurance plan, it would cost roughly $10,000 annually. With that difference, a family can buy a car or put that towards a down payment on a house, which are life-changing events.
The story that gets the attention of lawmakers is told by Dr. Lee Gross, the President of the physician advocacy group Docs 4 Patient Care Foundation and the founder of Epiphany Health (www.epiphanyhealth.org), one of the first DPC practices in the country. A patient of his came in with the bill from a recent emergency room visit for abdominal pain. Dr. Gross asked the patient why he didn’t just come to see him first because he would have done the exact same things at the hospital. The difference was that the hospital bill was almost $20,000, but at his office, the care was free, and the services that needed to be outsourced would have cost less than $300.
One may ask why we are not seeing more DPC practices. There are powerful forces working against this. The Trump administration needs to prioritize supporting DPC and making it easier for patients to access this care. At a time when there is a critical shortage of primary care doctors, Direct Primary Care may be the solution to this problem.