Various changes in the insurance industry, the consistent climb in health care costs, and limited viable coverage options drove medical practitioners to think outside the box to make their services available to patients. Direct Primary Care is the new, patient focused take on healthcare, and it’s creating an apparent shift in the way many Americans achieve and maintain wellness. The American Academy of Family Physicians defines DPC as “a meaningful alternative to fee-for-service insurance billing, typically by charging patients a monthly, quarterly, or annual fee (i.e., a retainer) that covers all or most primary care services including clinical, laboratory, consultative services, care coordination, and comprehensive care management.” Some DPC practices even choose to cover home visits.
The service is rapidly growing in popularity among medical practitioners as it offers benefits to both doctors and patients and encourages ongoing and preventative services that result in increased overall patient health. According to the DPC Coalition, more than 500 DPC practices operated across almost all of the United States in the fourth quarter of 2016 with moderate growth expected to continue in 2017.
According to DPC Frontier, a practice qualifies as a DPC provider if the practice charges a periodic fee and does not bill any third parties on a fee-for-service basis and if per-visit charges are less than the monthly equivalent of the periodic fee. These guidelines help to maintain physician control of practices and remove the middleman, making patient care the top priority and diminishing physician burnout.
Under the fee-for-service model, physicians are usually required to have a large staff to ensure health insurance reimbursement. As a result, overhead costs are significantly higher, claiming approximately 60 percent of revenue for a typical practice. To make up the cost difference, doctors must see an increased number of patients, meaning less time with each one. Additionally, this model causes most practices to spend an average of 30 percent of operating time on attempting to collect payment from insurance companies. Furthermore, insurers often require doctors to treat patients with specific procedures, testing, medications, or referrals to be eligible for reimbursement. Practicing in this manner does not guarantee the best interest of the patient and requires physicians to focus on satisfying insurance requirements to operate a functional, profitable business.
For patients who elect to participate in a DPC membership, getting in front of a doctor and receiving quality treatment becomes much easier. In a study of DPC trends in 2016, Direct Primary Care Journal reported that 49 percent of DPC practices disclosed having a wait time of less than five minutes per patient upon arrival. The norm for most fee-for-service practices requires patients to schedule appointments weeks in advance only to wait for up to an hour to see their doctors – or in most cases, physician’s assistants – for an average of only seven short minutes. DPC providers, however, typically have a member limit to ensure that patients receive adequate attention from their physicians. In many cases, with the ability to apply greater focus to each patient, DPC physicians eliminate the need for unnecessary tests and specialist referrals often required by insurance companies. Therefore, DPC providers provide top quality care based on the best interest of their patients without regard for the governance of health insurance providers.
Dr. Alberto Garcia recently opened the Valdosta Healthcare Club, the first DPC service available in his area.
“This option provides quality care at an affordable cost structure, the kind of coverage that has not been available for the uninsured population,” Garcia said. “This method of practice allows for an old-fashioned approach to doctor/patient relationships and provides the opportunity for physicians to effectively practice in a manner which best serves the patient without having to focus extensive time and energy on insurance administration.”
Garcia believes that in addition to the direct benefits for patients, DPC also helps to eliminate physician burnout by removing much of the red tape that results from insurance overreach.
Based on the wide variety of benefits to patients and medical practitioners alike, it is probable that DPC practices will become more prevalent in the coming years. Already present in South Georgia, look for DPC to make its way to the forefront of health care options available in your area.
Direct Primary Care: Changing America’s Healthcare Climate
By: Miranda Moore