Direct Primary Care (or DPC) is not a new model. In fact the DPC model has been used by practices for well over a decade and will be a format used by more healthcare providers in the years to come. In the DPC model, patients pay a monthly fee automatically (or a discounted lump sum for the year’s membership) and have a very minimal payment for visits and interactions with the doctor. Routine care is covered by the membership, including an annual wellness visit with appropriate blood work and in-office tests (breathing tests, EKGs, etc.). Repeat tests and other routine in-office needs will be covered by the copay. When care outside of the scope of the practice is required, the practice will make the appropriate referral/prescription for a service/medication covered by your insurance, or show you where to find the best cash price for that service or medication. I have always looked for the best deal for my patients and I’ve always taken economics into account in how I deliver care. Adopting the DPC model for my practice is consistent with my philosophy that healthcare should be holistic and account for the generalized wellness of patients, and certainly economics are part of the equation for all of us. DPC offers something long missing in primary medical care: control and transparency in the cost of your basic health care needs. The DPC model is not a form of insurance; indeed you will need to prepare for how you will pay for significant unusual medical services, like surgery or cancer treatment.
There is good documentation that even people with "premium" insurance that allows for all services on a copay and no deductible will find up to 12% savings in out of pocket medical costs with membership in a DPC practice. Those saving come with improvement in care and outcomes as well. How is such a thing possible? Because everything that happens in the medical world as governed by insurance happens at a full "retail" price set by the insurance companies, and these prices are higher than the "cash" price for the same services. This is true for medications, xray studies, and in fact most everything except the cost of physicians’ time. A regular occurrence over the years has been patients telling me that they’ve paid hundreds to thousands of dollars for blood tests or MRIs that the insurance deemed "not covered" and I’ve cringed each time knowing that the same tests could be had for a third or a quarter of the price if done through me on a cash basis. What this model offers is not insurance or a replacement for it. It’s simply your primary care needs being met in a reasonable fashion with transparent costs in a contract directly between you and the doctor, removing the middle man. As stated above, you will still need to obtain, or maintain, your medical insurance for all care you may need outside of my practice, such as: specialty services, in-patient and out-patient hospital services, high costs drugs, hi-tech imaging, such as MRIs, CT scans, and PET scans, emergency transportation, in-patient and out-patient rehabilitation facilities, etc.