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Direct Primary Care: What Physicians Need to Know

Direct Primary Care: What Physicians Need to Know

Direct Primary Care (DPC) triggers enthusiasm among healthcare service providers, primary-care physicians, and employers looking for better managed primary care. Basically, DPC typically involves patients paying a monthly fee to primary-care physician practices for basic primary care plus expanded physician/patient time and connection. Patients more easily visit their primary care physician, and can often e-mail or call the practice 24/7. Health plans are actively evaluating DPC-style patient engagement as plans shift reimbursement away from "fee-for-service" and toward care coordinating value and outcome compensation.

For a U.S. primary care practice to generate adequate plan revenue, they must visit face-to-face with too many patients each day. There is far too little time for each visit, and the practice has too large of a patient panel for the physician to develop strong patient recognition and interaction. Primary-care reimbursement has dropped as practice expenses have increased for many years. This is discouraging primary-care physicians financially, and in how they really want to practice medicine: They are "people" who want to connect and know the patients well enough to make solid front-line medical decisions. And for patients, plan-reimbursed primary care often means inconvenient office visits with long waits scheduled weeks in advance that are brief and trigger copays or deductibles. Patients tend to avoid the long waits and inconveniences, and the copays or deductibles, by avoiding the physician as long as possible. That leads to deferring primary-care visits until there is really a problem, and then the opportunity to delay or defer more expensive medical intervention is gone. The financial aspects of plan-reimbursed primary care fail to induce desired behaviors from patients and physicians. Patients are passive investors in "all-in" health plans, expecting robust healthcare intervention when needed. Physicians are paid for quick numerous office visits, but receive no compensation after a very busy day of office visits to further connect with patients. In sum, existing fee-for-service plan reimbursement misaligns financial incentive with desired outcomes, leading to excessive plan costs.

James J. Eischen James J. Eischen
With high-deductible U.S. health plans requiring more out-of-pocket payments, and with the obvious downside of developing chronic conditions that could have been avoided, the U.S. population should be willing to engage in healthier behavior modification for financial and personal reasons. But this healthcare economic investment upside is opaque, not transparent. Patients lack clear-cut financial value propositions sufficient to promote wellness investment. Plan-dependent primary-care physicians are largely on the outside of the wellness economy. The U.S. system is amazingly effective at high-cost intervention, but invests little in creating wellness incentives to reduce or avoid costly plan interventions. We plainly need to shift reimbursement to trigger desired outcomes, and that means shifting to incentivize desired behaviors from key stakeholders.

Plans really are shifting toward "value" and "outcome" reimbursement, but without clarity on: a) how to better compensate primary-care physicians to encourage direct early patient connection; and b) how to create direct patient engagement and investment in wellness. Private direct or DPC medicine tackles both issues. Direct patient subscription investment in primary care compensates physicians for direct patient connection.

If a simple all-in monthly fee for care works, why have HMOs not solved the U.S. healthcare problems? While HMO models internally coordinate care for a monthly premium, they lack a tangible engaged direct patient investment in preventative wellness. They lack primary-care physician compensation for direct patient connection. We need both to turn the corner on U.S. healthcare outcomes. Rather than trying to legislate small-business model outcomes (accountability, incentives, etc.), why not simply allow small businesses to deliver accountable and incentivized solutions?

DPC models involve free market direct patient subscription investments paid to physician practices as direct compensation to connect and coordinate care. DPC models enable improved opportunities to engage in badly needed patient behavior modification that cannot be accomplished in annual six minute office visits. DPC physicians like any small business owner are accountable for patient satisfaction, connected to their delivery, and incentivized to deliver improved care. Is that not exactly what the U.S. healthcare reimbursement reforms want?


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