For a while now I’ve been meaning to write a post about “Direct Primary Care” or “Concierge Medicine.” This is a trend that doesn’t get enough attention at a time when everyone is talking about creating sustainable models of care. Recently I received the nudge I needed to write this post. Patrick Jonas, MD, (@apjonas on Twitter), sent me a Tweet about the Direct Primary Care National Summit coming up October 11 & 12, 2013 in St. Louis, MO. (You may know of Dr. Jonas from his Dr. Synonymous Blog and the Dr. Synonymous Show on Blog Talk Radio.)
Here’s how Direct Primary Care is explained on the Direct Primary Care Coalition website (http://www.dpcare.org/):
“Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.
At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.”
Within this care model, patients pay a monthly membership fee and have nearly unlimited access to their primary care physician. The fee varies based on the profile of the patient.
One of the principles driving the move to direct primary care is the view that it is not pracitcal to have insurance pay for primary care and preventative medicine:
“Imagine if we relied on auto insurance for “primary care” for our vehicles (fluid changes, tire rotations, wiper blades). Think of the paperwork and billing hassles we would endure for each little oil change. The overall cost of auto maintenance would increase to cover the business overhead. Soon, fewer Americans would be able to afford auto insurance, with serious ramifications for liability, setting the stage for a national crisis. It’s a ridiculous idea, isn’t it? Yet this is the way that health care works in America today.
Approximately 90 percent of health care services provided today are referred to as primary care or preventive medicine. Placing these services under the umbrella of health insurance has driven up the cost, making even basic care unaffordable for many Americans.” (Source: dpcare.org website)
Physicians who run Direct Primary Care practices spend less time on paperwork and insurance issues, and have the opportunity to put more time into patient interactions. Typically, these physicians reduce the size of their patient panels and see far fewer patients. However, although patients are paying cash for primary care, they are encouraged to maintain a high deductable, low premium health insurance policy to cover emergencies and acute illness.
This is a fascinating trend, and one that is not without controversy. I’ve heard many stories about patients receiving letters from their physician stating that he or she is moving to the concierge model and to remain a patient, a $1500 per year retainer will be required. This happened to my parents and they paid the retainer. They saw this as a good thing, but not everyone does. To hear some of the criticisms of direct primary care, check out this Boston Globe opinion piece, “The Concierge Doctor Is In.” (At one point the author equates concierge medicine to gated communities. Wow.) And here’s a post from the Kevin MD blog, “Common criticisms of concierge medicine that deserve to be answered.”
Here are some great resources for learning more about Direct Primary Care:
- CNN Money Article
- MD News Story about Concierge Medicine
- Dr. Synonymous Blog Post: Direct Primary Care: It’s Not Just The Money
- Concierge Medicine Journal
- AAFP Article
- Bloomberg BusinessWeek
My thanks to Patrick Jonas for giving me the nudge I needed to finally write this blog post introducing Direct Primary Care.