Doctor Visits, With a Membership Fee: Direct Primary Care Gains Steam

In an effort to get around the complexities of the modern health insurance model, some facilities are taking a close look at direct primary care, which ties patients to a single physician or facility for a monthly membership fee.

In an age when picking a doctor is as easy as opening an app, it makes some sense that some in the medical field are looking for a way to boost loyalty toward individual doctors.

And that’s leading more primary care physicians to play with membership models. Direct primary care (DPC), a concept that has gained attention in recent years, involves individual patients paying a membership fee, generally on a monthly basis, for access to unlimited visits to a specific primary care physician.

Effectively, it’s the Netflix model for doctors—and it’s gotten some positive notice from those in the policy world hunting for an alternative to the Affordable Care Act. In a Wall Street Journal op-ed last year, the American Enterprise Institute’s James C. Capretta and Scott Gottlieb recently included DPC as one of the “four legs” they recommended for healthcare policy.

One benefit of this approach? It gets around the complexities of insurance claims processing, which often creates high administrative costs for individual medical facilities.

“Many membership medicine practices can have just one or two employees because billing is eliminated,” the publication Physicians Practice noted in 2015. “These savings are passed down to patients in lower fees, but also help keep physicians practicing independently.”

Those kinds of factors are leading some independent physicians to consider the model, according to a new survey from the American Association of Private Physicians and Kareo. The survey of 766 clinicians found that of the 75 percent of those surveyed who still rely on the traditional insurance model, 35 percent said they would consider switching to private models like DPC over the next three years. The survey also noted that those providers currently using DPC often saw fewer patients each month, allowing them more time to treat each one.

The model, still relatively experimental, has won some fans among individual doctors and those who prefer the market-based approach of DPC. In comments to WVTF, Charlottesville, Virginia-based physician Maura McLaughlin noted that the insurance model often comes with high overhead that doesn’t directly benefit the doctors.

“Use of insurance contributes to 40 percent of an average practice’s overhead,” McLaughlin told the radio station last week. “Every dollar that comes into a traditional practice—40 cents is immediately going out just to pay for the people that do all the billing and follow up with the insurance companies and get that money back. It’s not helping anyone.”

That said, DPC isn’t a perfect model for patients. For one thing, it isn’t a replacement for insurance for individuals—for more serious medical concerns, some policy experts suggest the traditional medical system is still necessary. In comments to WVTF, University of Virginia health policy expert Carolyn Engelhard emphasized these limits, along with the fact that the system exists outside of the Affordable Care Act’s parameters, could cause problems down the line.

“You can’t be banned for pre-existing conditions (under the Affordable Care Act),” Engelhard told the outlet. “You can’t be dropped because you’ve used too many services. All of that goes away under direct primary care.”


Ernie Smith

By Ernie Smith

Ernie Smith is a former senior editor for Associations Now. MORE

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