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9 Things to Know Before Switching to DPC

9 Things to Know Before Switching to DPC

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Direct primary care (DPC) is a throwback to an earlier time, where physicians abandon reliance on insurance in favor of a direct payment agreement with their physician. They may not be traveling to patients' homes, black bag in hand, but those embracing this approach are finding that, at least in part, it offers a welcome return to the medical practice of earlier times.

"Direct primary care is a new adaptation to an old concept," says Ripley Hollister, MD, a primary-care physician in Colorado Springs, Colo. "This concept is why many chose medicine as a career. They want to provide the best quality of medical care possible for their patients," says Hollister.

The DPC model is one many physicians find potentially attractive. In the Physicians Practice 2017 Great American Physician Survey, 63 percent of respondents said they would consider switching to DPC if circumstances were favorable. 

Before making such a move, what are some of the factors to consider? Here are thoughts from physicians with first-hand experience. 

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Physicians Practice


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Daniel @

This is exactly where I am thinking of taking my practice... to house calls.

Derek @

To Derek: I did house calls for 7 years. Here's something to consider: if you see Medicare patients, you must bill Medicare for the house call suing 99 code's. Many house calls to elderly clients involve more than 4 active diagnoses which will need more than the 99 code allows, so you are adding modifiers and billing for additional units of time. No problem, right? Wrong! I billed all my entended house calls correctly with 99 codes and modifiers. So then when Medicare sends a bundle of Remit Notices to the thrid party fraud recovery administrators, Medicare doesn't send all the billing (the primary 99 codes), they just send over the extended billing codes. Since the third party fraud unit doesn't see the primary billing they tap you as fradulent and Medicare withholds your pending accounts receivables. Oh yes, you can ask for a repeal, but they never side with the provider. I sent all of my primary and extended billing forms with the EOMs and remittance payments I received from Medicare to the 3rd party payors to show there was no fraud and no errors in billing. Didn't matter. The 3rd party payor still said I had committed fraud.
To completely get away from Medicare, you have to opt out for at least 3 years and once you do, you are not likely to get back into Medicare should you moonlight anyway else to supplement your income, so you will not be attractive to locum tenens who want temps who are Medicare eligible.

Choose your poison carefully. Been there, done that and it's all a loss no matter what the provider does.

Kara @

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