Sometimes dubbed “concierge care for the masses” by proponents, direct primary care refers to an emerging style of physician practice that’s driven in part by the frustration of patients and doctors alike about treatment time constraints.
For a monthly fee, generally $59- $89, patients can get all of their primary care covered—from an annual physical to treatment for various maladies and screening tests—with little or nothing more out of pocket. Neither the doctor nor the patient bills an insurer. However, direct primary care practices encourage patients to carry some kind of coverage for big-ticket items such as surgeries and cancer treatment.
Scarcely a decade old, the model appears to be gaining traction, particularly in the past few years. Data about the number of direct primary care practices and their overall cost-effectiveness remain limited. Most recently health savings accounts are being used to pay the monthly fees (Congress, 1989).
By not billing insurers, doctors say that they’re able to sharply reduce staff and other overhead costs, which allows them to still earn a living while treating a smaller panel of patients—generally 600–800 versus at least 2,000 patients for a traditional practice, according to the AAFP (American Academy of Family Practitioners, 2015). Thus, doctors can step off the “hamster wheel” of packing an increasing number of appointments into the same number of hours to offset lower reimbursement rates.
The feeling of going through a turnstile in many doctors’ offices is not lost on patients like Bill Benjamin, who signed up for Manning’s practice earlier this year. “All of the other doctors—it’s sort of like a cattle call, where they try to get as many people through so they can charge them,” says Benjamin, a fifty-two-year-old who has diabetes.
With the increasing proliferation of high-deductible plans, proponents argue that the time might be right for this fee-based approach. Patients with higher deductibles are paying more out of pocket, and they’re searching for more value for their buck. Nearly one-fourth of US workers are covered by a high-deductible plan with some type of savings option, such as a health savings account, according to data from the 2015 Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey (Kaiser Family Foundation, 2015). High-deductible plans also are being sold on the Affordable Care Act (ACA) health insurance exchanges.
References:
American Academy of Family Physicians . Direct primary care: an alternative practice model to the fee-for-service framework [Internet]. Leawood (KS) : AAFP ; 2014 Apr [cited 2015 Oct 30 ]. Available from: http://www.aafp.org/dam/AAFP/documents/practice_management/payment/DirectPrimaryCare.pdf
Congress.gov . S. 1989—Primary Care Enhancement Act [Internet]. Washington (DC) : US Congress ; 2015 Aug 5 [cited 2015 Oct 30 ]. Available from: https://www.congress.gov/114/bills/s1989/BILLS-114s1989is.pdf
Kaiser Family Foundation, Health Research and Educational Trust . 2015 Employer Health Benefits Survey: summary of findings [Internet]. Menlo Park (CA) : KFF ; 2015 Sep [cited 2015 Oct 30 ]. Available from: http://kff.org/report-section/ehbs-2015-summary-of-findings/
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