Imagine calling your doctor on the day you need to see him or her, heading over and spending a half-hour or more discussing the full range of your health concerns. He knows you well and even reminds you about some issues to discuss. Your doctor tells you that he wants look into one of your health issues more carefully, do some research and talk with a specialist, and he promises to call you back with a treatment plan—and he encourages you to e-mail or call him any time you have questions.
You notice that not only do you feel better about your doctor, but, compared with your last one, he seems less stressed and appears to enjoy providing such unrushed, attentive and personal care.
Is this all a dream? In a way, it is—an alternative to insurance-based fee-for-service health care dreamt up by primary care doctors including internists and family physicians who are fed up with the current high-pressure system that serves neither doctors nor patients well.
It’s called direct primary care (DPC). It’s a tiny movement, but it’s growing. It shares some features of concierge medicine, but it’s much less expensive and caters to the middle class rather than the affluent.
Can you believe its promises? And if so, would it work for you and your family? Here’s what you need to know.
HOW DPC WORKS
Most direct primary care practices don’t accept insurance, and they do charge a retainer, usually between $40 and $100 a month per person. Some charge on the lower end of that range for kids and on the higher end for older patients, who tend to have chronic conditions. In addition, some charge a small payment per visit, usually $5 to $20.
While DPC physicians don’t take insurance, if you use one, you’ll still want to carry some insurance. However, you can buy a less expensive, high-deductible plan…just enough to cover specialty care, emergencies and hospitalizations, such as a “bronze” plan under the health exchanges. If DPC gains popularity, more insurers will likely begin offering plans specifically tailored to work with the DPC model.
If you have Medicare, DPC can work, too, but it depends on the individual practice you sign up with. Since Medicare is insurance, many DPC physicians will not accept Medicare patients. But if you find a practice that does, you can work with them to have Medicare cover the services that the DPC doesn’t cover—you’ll also need to make sure that Medicare isn’t billed for services that the DPC covers, which would be illegal.
If you have a health savings account, you can still see a DPC physician, but you will not be allowed to pay the retainer with the HSA money. Bipartisan federal legislation is pending to remove this restriction.
THE DPC PROMISE
Why pay an extra fee each month? DPC advocates argue that the benefits are worth it, such as…
• Easier appointments—and more time with your doctor. DPC physicians tend to have a total of 600 to 800 patients rather than the typical 2,000 to 2,500. That makes it easier for your doctor to accommodate same-day visits and longer office visits. Most DPC doctors see 10 to 15 patients a day rather than the standard 20 to 30.
• More help from your doctor when you’re not there. With fewer patients, DPC doctors can build time into their schedules to communicate with patients via e-mail, Skype and phone consultations. Some offer this kind of access to your own doctor 24/7.
• Less paperwork. That means not only no insurance claims for usual care, but also that your doctor isn’t required to be typing documentation into a tablet or computer while he or she is supposed to be examining and advising you. “I didn’t go into medicine to be a computer programmer—I did it to work with patients,” says Robert Wergin, MD, board chair of the American Academy of Family Physicians, who still practices within the traditional insurance-based model but sees value in the DPC model.
The range of services that are included with the DPC retainer varies among physicians and is typically spelled out in a contract. But most provide everything you’d need for regular preventive care and sick care. Family physicians are trained to treat conditions that might normally be referred to a specialist, such as allergies, rashes, diabetes, gynecology and obstetrics care, and even most broken bones.
If you need a specialist, the physician will guide you and also negotiate fees for you. (Your insurance may pay as well, if you’ve met your deductible and copay requirement.) If you need a CAT scan, MRI or other imaging test, most DPCs negotiate with imaging centers to keep the costs down—and again, your insurance might well cover it. Some DPC physicians are also purchasing medications from pharmaceutical companies and distributing them to patients at cost.
IS DPC RIGHT FOR YOU?
DPC sounds great, but it’s important to note that it’s so new that it hasn’t been studied extensively by objective researchers. One recent report found that the overall patient costs are lower because the extra retainer costs are less than the money saved by buying cheaper insurance—but that study was done by a firm that consults for DPC physicians. Nor is there objective research that documents that the promises of DPC, such as more time with patients and greater patient satisfaction, regularly occur. There is also concern within the medical establishment that the DPC trend might leave out people who can’t afford the retainer, widening the already existing class system in medicine. And it’s so new that many states are still working out the regulatory requirements to set up practices.
Whether DPC is right for you depends on how comfortable you are with your current primary care provider—and what insurance policy you carry. If you don’t want to switch doctors, for example, it’s clearly not a good fit.
If you want to explore this new approach to medical care, the best action to take is to contact a local DPC practice and ask a lot of questions—what the fee is, what kinds of services are covered, what kind of insurance they recommend and, if you’re on Medicare, whether the practice is set up to accommodate you. Currently there are 141 practices with 273 locations spanning 39 states, with more on the way. Some are listed with the Direct Primary Care Coalition on its website. Or you can also search online for “direct primary care” in your area.
If DPC does turn out to be a good fit, you may be able to benefit from one of the most encouraging new trends in primary care medicine—a medical practice designed to meet the needs of patients…rather than insurance companies.