Direct primary care

In the United States, direct primary care (DPC) is a type of primary care billing and payment arrangement made between patients and medical providers, without involving insurance providers. It is an umbrella term, incorporating various delivery systems that involve direct financial relationships between patients and health care providers. ^[1] The American Academy of Family Physicians endorsed DPC. ^[2]

Structure

Direct primary care is promoted to save money on primary care services, as well as other ancillary services such as laboratory testing. Avoiding insurers eliminates the overhead and complexity of those relationships. The objective is to allow competition to drive access to higher quality care at lower prices. ^[3]

Fees are a combination of per-visit and/or monthly payments that cover a set of medical services, including same and next-day appointments, in office and/or at home. ^[4] Many DPC practices provide phone or email access.

Typically a DPC arrangement is paired with either:

• a high-deductible health plan, ^[1] as DPC alone does not cover catastrophic care such as most surgeries; or
• a health reimbursement account as the associated tax-benefits can generally be applied to DPC and other medical expenses;

One of the lesser known provisions of the 2010 Patient Protection and Affordable Care Act (ACA) is Section 1301 (and amendment Section 10104). This allows DPC to compete with traditional health insurance options in a health insurance exchange when combined with a low-cost, high-deductible plan.^{[ citation needed ]}

Onsite health is an emerging model involves the medical practice contracting with self-insured/funded) employers who offer DPC as a means of accessing care for free or reduced office visit fees. The employer pays the membership fees on behalf of the employee.

Another emerging model is partnering with HealthShare plans. Fees are sometimes reduced when participating in both a DPC practice and HealthShare plan. Coverage is more complete and affordable though still lacking certain services depending on both the DPC practice and Healthshare plan.

Advantages

DPC practices do not typically accept insurance payments, thus avoiding the associated overhead and complexity, which can take as much as 10–20 % of each dollar spent. ^[5] Patients are typically automatically billed, improving provider cash flow.

Rapid access to care can reduce the number of sick days or days of decreased productivity, benefitting the worker and the employer. ^[1]

DPC may encourage more doctors to provide primary care services or to continue practicing as they age, given the increased income, less-constrained time with each patient, and reduced administrative burden from insurance companies. ^[2]

Criticisms

Opponents of DPC models assert that DPC is unethical, primarily benefitting providers rather than patients. Proponents claim that using insurance companies as middlemen is unethical, primarily benefitting insurance companies over providers.

ACA requires DPC practices to include a secondary qualifying health plan (QHP) that covers other hospital services that the DPC provider may not offer if they participate in a healthcare exchange. DPC exchange patients are required to carry a catastrophic and hospital services insurance in addition to the DPC arrangement.

DPC plans can be more expensive in the long term, since by design none of the payments made to the DPC provider practice are counted towards insurance deductibles because the provider neither accepts insurance nor participates in the submission and management of the insurance claims process, potentially resulting in a higher out-of-pocket catastrophic or hospital services cost to the patient because deductibles would not necessarily have been reached when these services are provided. ^[2]

DPC provides a means for physicians to stop participating in the health insurance system, which reduces options for patients with conventional insurance. ^[2]

See also

• Consumer-driven health care
• Concierge medicine

References

1. "Direct Primary Care". direct-primary-care. Retrieved 2021-03-24.
2. Engelhard, Carolyn (13 October 2014). "Is direct primary care part of the solution or part of the problem?". TheHill.com. Retrieved 17 July 2015.
3. MD, Chad D. Savage. "Direct Primary Care: Update and Road Map for Patient-Centered Reforms". The Heritage Foundation. Archived from the original on June 28, 2021. Retrieved 2021-06-28.
4. Chase, Dave (2013-04-30). "On Retainer: Direct Primary Care Practices Bypass Insurance – California Health Care Foundation". California Health Care Foundation.
5. Pierre, Yong (2010). The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington DC: The National Academies Press. pp. 141–174. doi:10.17226/12750. ISBN   978-0-309-14433-9. PMID   21595114.