Direct Primary Care Model: Going Backward May Be What You Need

October 9, 2019 0 Comments
Direct Primary Care Model

Have you been yearning for an earlier time where providers weren’t reliant on insurance and had direct payment agreements with their patients? You aren’t alone.

In the Physicians Practice 2017 Great American Physician Survey, 63 percent of those surveyed stated that they would consider switching to Direct Primary Care (DPC) model if circumstances were favorable.

  • How would you determine if the conditions were favorable?
  • Or maybe that it’s just time for a change?

Ask yourself these questions:

  • Does it bother you that your nurses could be spending up to 40% of their time on paperwork for insurance companies?
  • Did you know that insurance payor contracts are less profitable than you think?
  • Would you like to feel as powerful as the insurance company when it comes to caring versus all those insurance rules and restrictions?
  • Would you prefer to make decisions exclusively for your patients’ well-being?
  • Do you prefer to have complete control over all your financials?
  • Do you want to save money and provide better care?
  • And not have to work with insurance companies anymore?

Do These Benefits Sound Good to You?

  • Patient care can be your #1 priority.
  • You will have:
    • More time with patients.
    • Less paperwork.
    • Less interaction with payers.
    • Interaction with fewer patients.
    • Lower overhead costs.
  • You will experience more professional satisfaction.
  • Better work-life balance is a given.

The Direct Primary Care Gives You the Ability to Do All of This

If you answered “yes” to any of these questions, it may be time to make the transition. To get a better understating of where these benefits are coming from, let’s take a quick look inside the fee structure of the direct primary care (DPC) model.

There are two significant differences between a traditional and a DPC practice:

  • In a DPC, the provider is paid directly by patients, not insurance or other third-parties.
  • In a DPC, the patient doesn’t pay for office visits. They pay a low monthly fee that runs $50 per month on average.

Hybrid Practice Models – Concierge Service

There are, of course, hybrid practice models like the concierge service. This model uses a monthly fee in addition to traditional insurance billing.

Legally a monthly fee can only be collected in addition to insurance billing if the monthly payments are for “uncovered services.” This practice provides the opportunity for significantly increased revenue, but it also increases the risk of double-billing for a single service. Double-billing has especially adverse repercussions if Medicare or Medicaid is the payer.

The Patient and the Fee

The “ideal” patient for a subscription-based practice is one that doesn’t use your services frequently but can see the value in paying a monthly fee. Any practice is much more likely to have frequent visits from a 70-year-old than a 30-year-old.

Because of this setting fees based on age (starting at a lower rate per month for children and increasing incrementally by age to a maximum charge per month for seniors) is a standard fee model.

The key here is not setting your prices too high for the younger patients and seeking generally healthy people who need you on occasion.

Debunking the Myths That Hover Around Direct Practices

The following statements are false:

  • Retainer practices are only for the wealthy.
  • Direct practices do not accept insurance.
  • If their provider has a direct practice, patients don’t need insurance.
  • Retainer practices make lots of money quickly.

Let’s Talk Benefits

Now let’s really dig into the benefits of transitioning to a DPC practice.

Benefit #1 – Predictability of revenue.

With a monthly commitment from patients, overall income is predictable, and the flow of revenue is steady throughout the month. This makes cash-flow easy to navigate. When you crunch the numbers, you will also find you require fewer patients with the DPC model than the FSF model.

Benefit #2 -Patients come in for fewer unnecessary visits.

Many patients visits are to:

  • Touch base about medication changes
  • Discuss minor acute problems (URI’s, stomach bugs, etc.)
  • Fill out work/school forms

Many of these visits can easily be handled remotely. With the DPC model, you can give patients a variety of ways to access you and your staff that doesn’t require them coming in for an office visit.

Benefit #3 – Alternative care communication alleviates pressure on the staff.

It also keeps patients from having to wait forever on the automated phone line. Secure text messaging can be used effectively to answer many questions people have about smaller health problems.

Simple things like rashes and acute illnesses can be communicated easier by text. Follow-ups to ask how patients are doing via a quick message is convenient and makes the patient feel cared for.

Benefit #4 – A decreased volume of unnecessary visits opens up the schedule.

There is no benefit to being fully booked. In fact, you will be rewarded for having a relatively open schedule at the start of the day. An open schedule also quells patient’s fears about not having access to their providers.

And appointments are no longer hard to get or too short. With an open schedule, patients easily get same-day appointments and the attention that they deserve.

Also, keep in mind patients are paying you monthly, so they get access to your care, not necessarily for the care itself. Never fear, you will be paid just as much on a slow day as a busy one.

Benefit #5 – In this model of care, patients have longer appointments.

Let’s emphasize that last point: longer appointments allow time to explain, educate, listen, consider, and connect. You can get the whole story from a patient and treat them accordingly rather than only being able to focus on one single problem. This equals better care and happy patients.

Benefit #6 – You are more likely to run on time.

With the DPC model, you are no longer tied to the office visit as the only profitable means to give care. Healthy patients are no less profitable for your business. In fact, they leave the schedule more open than do sick patients.

Benefit #7 – The elimination of the need to interact with payers.

This one is big. Imagine all of the time and energy saved if you and your staff are not spending it on administrative functions like verifying documentation requirements or getting prior authorizations.

Not to mention that there will be less focus on dealing with electronic health records and desk work that often contribute to burnout.

The Downside

We would be remiss if we didn’t mention the potential drawbacks. Here are eight things you may experience when you choose the DPC model.

  • Your income may be lower when you first start out.
  • You may feel isolated.
  • You may have fewer patients than you are used to.
  • Other nonretainer-based practices may become overburdened.
  • You may have difficulty recruiting patients and building your patient base.
  • Insurers may not cover services.
  • Best practices in this model have not yet been identified.

Where the AMA Code of Medical Lands

If you are interested in starting a DPC but concerned about how this model of practice fits in with the AMA Code of Medical ethics, you do not need to worry. The AMA supports a  providers’ right to choose their practice setting and has not only offered an opinion but guidance on retainer practices.

The DPC footprint is still small, but there are enough pioneers out there that you can easily research how others have made the transition. Those embracing the DPC approach are finding that it offers a welcome return to the medical practice of earlier times.

This isn’t just nostalgia. Running a profitable DPC business is attainable. It is possible to prioritize your patients. You can remove yourself from your worst insurance contracts and still thrive financially.

We Are Here for You

Whether you make the switch to the DPC model or not, EvexiPEL is here for you, and we would love to be part of your practice. When you become an EvexiPEL provider, we provide for you!

1. We Provide Training

We give our providers access to superior online training and in-person medical training.

2. We Provide Proprietary Information

We let you in on our proprietary pellet formulation, and we know hormone pellet providers who don’t practice with EvexiPEL:

  • Often receive complaints from pellet patients
  • Have patients who try pellet therapy once and then give up
  • Can become frustrated with the whole thing

With EvexiPEL’s proven and successful pellet formulation and excellent resources, you won’t have to deal with these issues anymore.

3. We Provide Practice Development Specialists

We have trained Practice Development Specialists to support you as you build your BHRT practice.

4. We Provide a Business Support System

And after you build your practice, we’ve got comprehensive business support systems to make sure you’re still getting the support you need!

We’ll even provide:

  • An electronic health records system
  • Innovative marketing systems
  • A comprehensive patient follow-up system

And we won’t charge you a penny! Become an EvexiPEL provider today!


Article Name
Direct Primary Care Model: Going Backward May Be What You Need
Whether you make the switch to the DPC model or not, EvexiPEL is here for you and we would love to be part of your practice. When you become an EvexiPEL provider we provide for you!