What is Direct Primary Care?
Direct primary care (DPC) is an alternative to the traditional fee-for-service model of primary care where instead of billing a patient’s insurance for services rendered physicians charge patients a modest retainer fee directly in exchange for providing immediate and unlimited access, longer appointment times, and intensive coordination of care. The retainer fee is typically between $60 and $150 per patient per month. Direct primary care began as a movement in the early 2000s as a way to provide medical care to people with no health insurance. Since then it’s become a way for all individuals and employers to obtain better access to medical care, to obtain better quality of care, and to lower overall healthcare costs regardless of their health insurance status. The main way direct primary care achieves this “triple aim” is by providing physicians more time to spend with patients. Patients pay a low monthly subscription fee for unlimited access to their own physician via in-person visits, telephone calls, and texts. Bypassing insurance and charging a flat monthly fee directly to patients enables direct primary care medical practices to cut out anywhere between 30 to 40 percent of their overhead (billing, coding, insurance reimbursement, and so on). This enables direct primary care physicians to reduce the number of patients for whom they care—typically down to no more than 600. In contrast, primary care physicians practicing in the traditional fee-for-service model usually care for 2,500 to 4,000 patients, seeing 20 to 22 of them per day (insurance reimbursement rates for primary care visits are low and the cost of running a primary care practice is high so the only way fee-for-service primary care physicians can survive financially is by piling scores of patients into their practices).
Why are Patients Interested in Direct Primary Care?
One reason for the mounting interest in direct primary care among patients is the lack of time that physicians have available to spend with them in the traditional fee-for-service model. The average length of time it takes to be seen by a primary care doctor is 19.5 days. Once the patient arrives, 30 percent of them wait 20 to 40 minutes to be seen. And once they’re in the exam room, the average length of time a primary care visit lasts is only 15.7 minutes. For simple issues like back pain this might be enough. But for patients with multiple, complex issues it’s completely inadequate—and further leaves no time to address important topics that require extended dialogue (like end-of-life care in patients with terminal illnesses, for instance). Further, dealing effectively with important emotional issues—stress, anxiety, depression, and so on—in such a timeframe is nearly impossible, as are meaningful and effective discussions surrounding preventive care. In contrast, with patient panel sizes that are 70 to 80 percent smaller than seen in traditional fee-for-service practices, a direct primary care physician can spend time enough with each patient to be able to manage 80 percent of the their medical issues.
Because of time constraints inherent in traditional fee-for-service practices, traditional primary care physicians often can’t adequately address issues within their own expertise and as a result must refer their patients out to more costly specialists who run more tests and order invasive treatments, many of which are unnecessary, leading to an increased likelihood of complications and additional out-of-pockets costs for individual patients and/or their employers if the patient is covered in a self-insured health plan.
What are the Benefits of Direct Primary Care?
In contrast, direct primary care physicians spend far more time with each patient because they have far fewer patients in their practices. This allows them to care for their patients in the most comprehensive manner possible. For example, when calling after-hours, patients in a direct primary care practice can expect to talk to their own physician rather than to a nurse or an on-call physician (other than during vacation times). Direct primary care allows patients and doctors to develop a close, trusting relationship, which fosters open communication and increased compliance with medical advice, both of which have been demonstrated to lead to better health outcomes. In the direct primary care model, physicians finally have enough time to gather complete medical histories, perform thorough physical exams, to think through challenging diagnostic dilemmas, and to search the medical literature to find answers when answers aren’t immediately obvious—as well as enough time to explain their thinking clearly enough for patients to understand it precisely. Direct primary care physicians also have time to get to know their patients in a way that enables them to tailor their medical advice to each patient’s lifestyle and values.
With direct primary care patients at last have in their doctors what they’ve always wanted: a trusted healthcare partner who cares both for and about each of them as they would members of their own family.