Direct Primary Care-A New Model for Healthcare?

[tjscott0]

The Shrinking Number of Primary Care Physicians Is Reaching a Tipping Point -...

I’ve been receiving an escalating stream of panicked emails from people telling me their longtime physician was retiring, was no longer taking their insurance, or had gone concierge and would no longer see them unless they ponied up a hefty annual fee. They have said they couldn’t find another primary care doctor who could take them on or who offered a new-patient appointment sooner than months away.

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Direct primary care cuts out insurance companies. Could it gain traction...

Andrea Meneses stumbled on a direct primary care clinic because of a crisis.

Her grandmother, visiting Wisconsin from Bolivia, did not have insurance but needed to see a doctor fast. One of the grandchildren accidentally put her insulin in the freezer instead of the refrigerator.

Meneses reached out to friends in a panic, and one recommended Dr. Wendy Molaska, who runs a direct primary care clinic in nearby Madison. Patients at these clinics pay a fee of roughly $50 to $100 month and get easier, direct access to their doctor — as often as they want for no extra cost.

Direct Primary Care Doctor Fees | Decent

DPC advocates often tout the model’s benefits, which include extended appointment times, personalized care, and greater accessibility to a physician. It is particularly beneficial for those with chronic conditions who require consistent care service. However, despite the obvious advantages, DPC is not without its drawbacks. It does not typically cover specialist or emergency services, which means patients often retain a high-deductible health plan (HDHP) for catastrophic events.

Most DPC practices charge a monthly fee that typically ranges from $50 to $150. This fee generally includes a variety of care services, such as annual physicals, routine lab work, and basic procedural services.

Direct primary care cuts out the insurance company. The patient is paying for the basic healthcare at a set fee. Also since insurance is not involved a set transparent fee schedule would be available at the primary care doctor’s office.
As stated above the patient will require a major medical policy with a thousand or $5k deductible. But I would think that the cost of such a policy would be much less than in which the insurance company was paying for preventive and annual visits.

Of course the Medicaid program will still be needed as there are folks that cannot afford medical insurance.

[DrBob2]

What are the differences between DPC and concierge care?

DB2

[VeeEnn]

@DrBob2

What are the differences between DPC and concierge care

DB2

None really. Direct care/concierge care/insurance independent care are terms that’ve been bandied around since the early aughts (before that in dentistry) …the benefits being touted heavily by the entrepreneurs promoting the idea to physicians and the public alike.

In practice, the concept is no different to any of the capitation plans that’ve been tried over the decades…the most obviously recognizable being Medicare Advantage. In a nutshell, it’s designed to provide a steady predictable income with which to build a business…paying your fixed overhead, employee compensation packages, and the overheads associated with providing a service to the folk who sign up. Anyone who’s given this model a shot over the years (and I suspect that the market is pretty well saturated by now) will see at a glance that, with the fees mentioned in the articles, it’s going to take a heck of a lot of healthy individuals making minimal demands on a practice to go anywhere close to covering practice overheads.

[intercst]

Don’t forget that your Direct Primary Care Physician can’t bill Medicare if he’s getting a $50 to $100/month up front fee from you – that would be fraud. If he orders $500 worth of lab tests that would normally be covered without cost by Medicare, you’re going to pay out of pocket – and probably at the full unlimited price gouging rate rather than the Medicare reimbursement for the service.

The only way this would work is if your DPC doctor referred you to a specialist (who participates in Medicare) for literally everything and never did anything himself.

Need a simple blood test to check your glucose? Get a referral to an Endocrinologist and have him order the test.

I’d only sign up for one of these schemes if the DPC doctor had a list of 5-star medical specialists on the roster that would accept his referrals in a timely manner.

Direct Primary Care Offers More Access, but Medicare Won’t Pay - NerdWallet

Also you should note the most DPC practices charge higher fees for those over age 65 since they have more medical problems. As VeeEnn points out, this model only works if most of the DPC’s patients never come to see him.

intercst

[JLC]

@intercst

If he orders $500 worth of lab tests that would normally be covered without cost by Medicare, you’re going to pay out of pocket – and probably at the full unlimited price gouging rate rather than the Medicare reimbursement for the service.

Like everything, depends.

We do Direct Primary Care for our physician access. Like many, he used to be in a traditional practice. He has negotiated prices with a local lab. We get twice a year labs: chem 20, CBC, and PSA for me. Anything else that needs looking into is pretty much at Medicare prices. There has been a few things he has negotiated to a lower price than what would be insurance out of pocket.

This group also includes a nutritionist/dietician on staff and someone to help you start a basic exercise program with group classes on site 2-3 times a week.

Our DPC is very into preventative care and lifestyle changes.

[intercst]

@JLC

We do Direct Primary Care for our physician access. Like many, he used to be in a traditional practice. He has negotiated prices with a local lab. We get twice a year labs: chem 20, CBC, and PSA for me. Anything else that needs looking into is pretty much at Medicare prices. There has been a few things he has negotiated to a lower price than what would be insurance out of pocket.

Lab work done under Medicare is 100% cost-free to the patient. If you’re over age 65, why pay twice for something you’re already covered for?

intercst

[JLC]

We are not over 65 so not paying twice but getting a good discount. Like I said, often less than insurance co-pay.