Direct Pay Primary Care Model: Considering Taking the Leap?

September 11, 2019 0 Comments
Direct Pay Primary Care Model

Are you fed up with the complexities involved in trying to work in the health insurance model of healthcare?

  • Paperwork
  •  Coding
  • Patients coming and going because their provider networks keep changing

This isn’t what you got into medicine for. You got into medicine to help people and have long-term relationships with your patients. Achieving your dream is still possible, but it will take a leap and some hard work to transition into a healthcare model that supports it.

The good news is pioneers have already started clearing the path back to that model, a Direct Pay Primary Care Model. We know if you are already a practicing doctor or practitioner, you’ve got what it takes to start your own Direct Pay Primary Care Model. And you’ve already taken the first step just by reading this article!

Where to Start

Do your homework first. Direct Primary Care (DPC) Frontier has a great online resources page that can get you started. Combine your online research with in-person interviews.

Talk with other doctors who have walked the path before you. They will have special insights into what worked for them and what didn’t, and you can also ask them any unanswered questions.

1. What Are the Best Geographic Locations for Your DPC?

Urban and suburban practices tend to be most successful. Although practices can thrive in rural areas, they can present more challenges.

2. Planning on Dispensing Medicine Directly to Patients?

Be aware eleven states prohibit direct dispensation of medicine to clients. If you plan on dispensing medication directly, check this overview, your state’s webpage, or contact your state medical board.

3. Do You Want to Run a “Pure” or “Hybrid” Practice?

Are you planning to “Opt-Out” of Medicare? Opting out is a straightforward process that can be found on the Association of American Physicians & Surgeon’s “How to Opt-Out of Medicare” webpage.

4. Do You Want to Be Independent, Join a Network, or Be Employed by a DPC?

Moonlighting part-time in a Direct Pay Primary Care Model onsite clinic could help you learn more about how you would like to run your clinic. You could even use the moonlighting income as a financial stabilizer until your practice takes off.

5. Where Do You Want Your Office Space to Be Located?

A functional office space is essential unless you are creating a micro-practice. Do you want your office space to be located in a:

  • Medical center
  • Strip mall in a struggling economic area
  • Less conventional more cozy space like an old house zoned for an office space

Think about the clients you want to serve, what they would be attracted to, and what you are most comfortable with.

6. Does Your Staff Believe In What You?

They will work harder, care more about the practice, and stick around longer. Their commitment to your practice will attract and retain more patients, as well.

7. Do You Have the Right Communication Tools?

The right communication tools are invaluable. Patients place a high value on access to staff. In fact, most patients value security in communication over ease of use. Make sure you invest in the following:

  • A good phone system like Ring Central is a complex, inexpensive VOIP Internet phone system.
  • A strong messaging system like Twistle is a HIPAA-compliant “chat” system.
  • A secure system for e-mails. Although not the preferred form of communication in this business, as long as patients sign a HIPAA waiver, it is technically acceptable to use e-mail for communications if a patient prefers this method.

8. Did You Know Billing Systems Will Make or Break You and Your Staff?

Choose a billing system that is:

  • Easy for the staff to work with
  • Intuitive for patients to navigate
  • Able to integrate with EHR systems

9. Have You Considered the Money Side?

Draft an estimated budget for your practice and determine how much capital will be needed to start it. There are many ways to minimize the amount of start-up capital required, such as purchasing used equipment from hospital surplus facilities.

You can also be creative with costs around buying or leasing your office space. Some DPC micro-practice concepts avoid using an office space completely.

10. Have You Solidified Your Fee Schedule?

Create your fee schedule using price transparency. Determine the cost of services provided in your practice (labs, medications, pathology, basic procedures) then decide whether you will pass these through to the patient via an itemized list.

For services outside of your practice like surgery centers, radiology groups, specialists, and hospitals in the community, it may be more difficult to provide price transparency to your clients as these businesses are not always transparent with their pricing.

You can, however, work with specialist physicians in the community to establish a transparent cash price referral system for their services. If they are not already aware, educate these specialists about the fact that even though they may continue to participate in Medicare, they are no longer barred from offering prices below the Medicare reimbursement amount to cash-paying patients.

11. Have You Considered the Legal Side?

Draft your Direct Pay Primary Care Model patient-physician contract. This contract will reflect your practice preferences in alignment with state and federal law. Familiarize yourself with your state’s insurance code so as not to violate state insurance law or have your practice end up being labeled a health maintenance organization.

Assemble HIPAA forms, Medicare Opted-Out Agreements, and any needed registrations. Look at OSHA and CLIA rules. If you are running a “pure” DPC practice and have opted out of Medicare, you may now be less concerned about the False Claims Act and Stark Laws.

Consult an attorney who is familiar with direct primary care to draft or review your legal documents. You can cut down on legal costs if you draft the items on your own and then run your ideas by a contract attorney.

Attorneys familiar with DPC practices are still a rare find since DPC is only beginning to experience exponential growth.

12. What About Marketing?

Start by deciding which (if not all) of these three groups you will market to:

Individual Patients

  • Word of mouth is still priceless. If people like you and your practice offers immediate value, they will tell their friends.
  • Paid advertising such as newspaper advertisements are not effective, but many DPC physicians have had success with radio advertisements.
  • Facebook or other social media outlets provide an easy communication tool for patients and those interested in your practice. You can also promote posts on FB that target the exact demographic that you are interested in.


Employers basically come in three sizes:

  • Small (less than 50 employees)
  • Midsize (50-150)
  • Large (> 150)

Employers’ needs and tax implications will vary based on their size. The conversation you will have with those that have less than 50 employees will be fairly simple. With mid-size or large companies, you will either need to have an understanding of it or bring a consultant with you that has an understanding of the concepts of stop loss or level-funded health plans.

Third-party Organizations

These organizations might include the following:

  • Insurance Carriers, Brokers, Third Party Administrators
  • Medicaid Managed Care Pilots Medicare Advantage Pilots

You may find that self-insurance broker and third party administrators are happy to steer patients to your practice because the Direct Pay Primary Care Model aligns so well with the price-sensitive plans that they offer.

Regardless of which of the three basic groups you are targeting, it is important to start your practice’s website. You can direct people there from any of these groups to learn more about you and your practice.

We Are Here to Support You

Whether you decide to start your own Direct Pay Primary Care Model practice, EvexiPEL is here to support you in whatever way we can. Perhaps you don’t feel that you’ve been able to connect with as many patients as you’d like.

Maybe you don’t feel yours have the right resources to provide them with life-changing approaches and treatments. Maybe you feel like your practice is in a rut, or you are simply looking for further training and education.

Becoming a certified EvexiPEL provider can help you grow your practice, sharpen your skills, learn a world-class hormone treatment, and help more patients.

When you become a certified provider, you’re getting:

  • Access to leading resources like hands-on practice with real EvexiPEL patients
  • Training under some of the most renowned hormone specialists in the world
  • Lasting practice support from a Practice Development Specialist

We make sure all of the bases are covered, and we’ll lead you every step of the way, from training to marketing.

How Do You Get Started?

Fill out our online contact form. We will get back to you to explain more about the EvexiPEL method, how you can reach patients, and answer any questions you may have.

Then we’ll send a Practice Development Specialist to learn about your history and your future goals, all while guiding you through comprehensive training.

Finally, you can focus on delivering quality service to your patients while we focus on providing you with long-term support and resources to enable your success!


Article Name
Direct Pay Primary Care Model: Considering Taking the Leap?
Fed up with the complexities involved in trying to work in the health insurance model of healthcare. Then, the Direct Pay Primary Care Model may be for you. EvexiPEL is here to support you in whatever way we can.