History of direct primary care practices

Although the concept of the direct primary care (DPC) practice actually harkens back to before the days of insurance payments and regulations, the DPC model itself has only been around since the turn of the 21st century. The DPC model operates on patient membership fees. DPC practices generally do not accept insurance, although most will encourage patients to secure catastrophic insurance for those services not provided in their basic membership. The DPC was originally the brainchild of three doctors, who had the “idea to go insurance-free, charging monthly fees instead and freeing up time to enjoy practicing medicine.” Their goal was to establish a practice that would provide quality care at a predetermined cost, so patients would know what to expect. The practice these three doctors formed, Qliance, was backed by Amazon CEO Jeff Bezos and Dell founder Michael Dell. Qliance had built its membership up to over 25,000 patients before it closed its doors in 2017 (apparently due to reasons unrelated to the DPC model). DPC’s concept is for the independent physician to provide quality, personalized care to a smaller patient panel. This idea has been appealing to a growing number of providers who have launched their own DPC practice over the past couple of decades. While patients must usually be educated as to the model’s structure, the DPC is particularly enticing given the rising costs of healthcare and insurance coverage. DPCs gained a bit more traction recently when the American Academy of Family Physicians (AAFP) issued a statement that “the DPC model is consistent with the American Academy of Family Physicians' (AAFP) advocacy of the advanced primary care functions and a blended payment method of paying family medicine practices.” AAFP cited the fact that the “DPC contract fee structure can enable physicians to spend more time with their patients, both in face-to-face visits, and through telephonic or electronic communications mediums should they choose, since they are not bound by insurance reimbursement restrictions.” The DPC has a relatively short history, but is a growing concept and by most accounts, is a medical practice model that is here to stay.

Gabby Marquez
January 12, 2018

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DPC pricing for 2018: should you change your membership fee at your practice?

The end of the year is a good time to review the operations and management of your direct primary care (DPC) practice. You might think about marketing more in the upcoming year, to increase your patient panel. You might also consider whether you need to add or reduce your staff level. One question that can impact your practice significantly is the membership fee you charge your patients each month. Now would be a good time to determine whether that membership fee for your DPC practice needs to be changed. The Direct Primary Care Journal is conducting a survey to determine whether you are increasing your membership fees in 2018 as well as the annual salary for a DPC physician. You can still provide your input into this survey. So far, the results are showing that most DPC membership fees will remain the same in 2018 as they were in 2017. Half of the survey respondents indicate that they will not change their fees from 2017 to 2018. In fact, about a third of the respondents have indicated that they have not changed their DPC membership fees since at least 2015. Only 8% of the survey respondents to date have said they plan to raise their fees, about $20 a month for each member. No one has indicated they would raise fees any higher. No one has said they are afraid to raise fees because they might lose patients. Just over a quarter of those responding to the question regarding physician salary say they are in their first year of their DPC practice. Of those who have been in a DPC practice more than one year, 10.53% said their salary had increased in 2017 and 5.26% said their salary actually decreased in 2017. Just over 21% of the respondents said their salary was less than $100,000 a year.

Greg Miller
December 20, 2017

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The Do's and Don'ts of DPC physician marketing

As a direct primary care (DPC) physician, you have an added challenge of educating patients about the DPC model as you market your own practice. Many potential patients may not understand how the DPC practice works, so you will need to incorporate that information into your marketing efforts to successfully promote your services and staff. Elation has published the Direct Care Playbook, which includes a section on effective marketing strategies that should prove helpful to your practice. The “do’s” of marketing as a DPC physician include: Make sure your current patients are happy, so they will spread the word! Word of mouth is without a doubt the most effective marketing technique you can employ. When your patients do the networking for you, it’s even better! Do your own networking in your community. Attend events, sponsor community and business activities, and make your name known in a positive way. Have an active online presence. In today’s digital world, potential patients look at websites and social media to determine which medical practice might work best for them. Make sure all of your relevant information is listed on your website, including contact information, hours of operations, and qualifications of you and your staff. Add an educational note about the benefits of the DPC model. Be consistent with your brand. Determine the image you want for your DPC practice and be sure that all of your marketing efforts relate back to that image, online and in person. A few of the “don’ts of marketing” include: Don’t offer discounts or “sales” to entice new patients. You can actually be penalized for this, as it is illegal for a medical practice. Don’t get impatient with your marketing efforts. It takes time to get your practice known and to have your name become recognized in your community. Don’t violate HIPAA rules when posting on social media or your website. Online content cannot disclose any protected patient information. Don’t overuse medical terms when posting on social media or your website. Potential patients want to be able to understand the services you provide in clear terms that they can understand. Marketing your DPC practice can be challenging but rewarding. Elation’s Direct Care Playbook can help!

Gabby Marquez
December 6, 2017

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Direct primary care and physician burnout

The burnout that independent physicians experience is a very real and increasingly significant challenge. Factors contributing to their burnout include being overwhelmed with paperwork, dealing with insurance reimbursements, and the burden of complying with regulations such as those included in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requirements. In addition, most independent physicians are charged with the care of a very large patient panel, necessary to keep their practice financially solvent and to meet reimbursement requirements. According to a study supported by the Mayo Clinic Program on Physician Well-being, there has been an upsurge in the number of physicians reporting at least one sign of burnout over the past several years. The study report concludes that “Burnout and satisfaction with work-life balance in US physicians worsened from 2011 to 2014. More than half of US physicians are now experiencing professional burnout.” How can the direct primary care (DPC) model contribute to relieving independent physicians of many of these burnout factors? Smaller patient panel. DPC physicians generally see fewer patients per day. The practice does not charge a fee or co-pay for each visit, so there is no incentive to see more patients. The number of patients enrolled in the DPC’s membership fee plan determines the financial stability of the practice, not the number of daily patient visits. Increased focus on patient care. With fewer patients comes more time to focus on each patient during the visit. Patients in a DPC practice are also encouraged to communicate with the provider outside of the office visit, for questions or clarifications. No insurance reimbursements. The DPC model operates on patient membership fees and generally does not accept insurance from patients. The burden of filing and waiting for reimbursement is virtually eliminated in a DPC practice. A simpler model. DPCs have a simple, straight-forward structure that helps reduce the stress of practice management and therefore helps reduce physician burnout.

Greg Miller
November 28, 2017

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Perspectives from an employed-turned DPC doctor

The entrepreneurial spirit is still alive and well in the medical field. Independent physicians who want to retain control of their practice, including having the ability to focus more on their patients’ care, are deciding that working as an employee for a hospital or for a larger practice is just not the right fit for them. Likewise, many independent physicians are realizing the benefits of the direct primary care (DPC) model, for themselves as well as for their patients. DPC physicians tend to have fewer patients and more time to spend with each patient during the visit. In addition, DPC patients enjoy more contact outside the provider’s office, with the opportunity to communicate with the physician regarding healthcare instructions, medication questions, and other concerns. Physicians Practice recently interviewed one doctor who decided he wanted this kind of practice for himself and his patients. Landon Roussel, MD, began his medical career as a contract employee of a large healthcare provider. His original contract was supposed to last for one year, but after six months he and his employer parted ways amicably. Dr. Roussel states that he was dissatisfied with his work as an employed hospitalist because he felt that “quality was secondary” to revenue-generating relative value units. Dr. Roussel launched Communitas Primary Care, a DPC practice to be able to better serve his patients and to stave off potential future burnout for himself as a physician. Dr. Roussel is adamant that “all physicians should be as independent as possible,” for their own benefit as well as for their patients’. There are challenges with launching an independent practice, particularly one based on the DPC model. Dr. Roussel recognizes the reality of those challenges, but says “at least I can rest comfortably knowing I did my best and did the right thing.” His practice is only about half full at this point, but he has been actively marketing and expects to have a full panel by the end of 2017.

Greg Miller
November 20, 2017

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What is a hybrid concierge practice?

Independent physicians are experiencing burnout at increasing rates, primarily because of the burden of administrative reporting and regulations but also because of their increased patient load. At the same time, patients want a higher quality relationship with their physician. They want better access to their provider and they want their provider to take the time to listen to them. The personalized service offered as part of the concierge practice model may be a tempting solution for many physicians, but there are some drawbacks. The ideal solution for both provider and patient may be the hybrid concierge practice. The concierge practice relies on patient membership fees, which can range from a few hundred dollars to thousands of dollars a month. The concierge provider does not accept insurance payments and sees fewer patients, reducing the stress of billing and reimbursement and providing each patient with more time during the visit. Concierge physicians can give much more personal service to each patient, given the structure of the practice. The hybrid concierge practice offers an alternative for the established physician who wants to provide concierge medicine but who does not want to lose current patients or the steady income generated by insurance payments. Hybrid practices provide patients with the option of switching to membership-based concierge medicine, while reassuring all current patients they can continue seeing the physician regardless of their payment models. Dr. Cynthia Williams, a board-certified internal medicine physician practicing in Houston, says that she opted for the hybrid concierge model because it “can provide a solution for many of the issues affecting our current healthcare system, primarily: adequate reimbursement; recognition of the important role doctors play in patients' health; and giving patients choices in the types of healthcare services they receive.” In a hybrid concierge practice, all patients receive the same level of care; however, those who opt for the concierge service receive more time and convenience, particularly around scheduling and communicating with their physician outside the visit. As Dr. Williams states, the hybrid concierge practice model “makes the workday less stressful and more enjoyable, which is good for physicians, patients and staff.”

Gabby Marquez
November 17, 2017

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Questions to consider when starting a new DPC practice

Whether launching a new practice or transitioning your current practice, there is a lot to consider when preparing for a direct primary care (DPC) model as an independent physician. You undoubtedly already have a lot of questions about how the DPC model works and whether it will, in fact, work for you and your practice. There are a number of factors you should consider that can help you as you prepare to start a new DPC practice. Why should you consider the DPC model for your practice? As the American Academy of Family Physicians (AAFP) points out, an appealing aspect of the DPC model “for family physicians is that the retainer fee payment structure can greatly simplify the business of operating a family practice.” DPC practices typically do not accept insurance and so have reduced overhead expenses, particularly regarding office staff requirements. As a result, “DPC practices report significantly reduced operating rates when compared with traditional primary care practices.” Are you financially stable enough to start up a new DPC practice? The downside of the DPC model’s membership fee structure is that it may take time to build up a patient panel solid enough to cover expenses. You will need to set your membership fee structure, to make it realistic for your needs as well as for your patients’ needs. Elation Health’s Direct Care Playbook provides a simple calculation example that can help with setting appropriate fees. Do you want to spend more time with patients? The DPC model enables independent physicians to spend more time with each patient during their visits. The practice’s patient panel is generally smaller than in a traditional practice and, because of the financial structure, the independent physician can then spend less time on practice management. Do you have the right technology for your new DPC practice? An electronic health record (EHR) solution will help you manage patient information more efficiently. You will have immediate access to patient data that will enable you to focus more on your patients, improving healthcare outcomes and improving the health of your new DPC practice!

Gabby Marquez
November 14, 2017

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The role of direct primary care for the uninsured

Insurance premiums and deductibles are on the rise. Many people appear to be frustrated with the debates and difficulties surrounding the Affordable Care Act (ACA). Health insurance has become a complicated and often unaffordable purchase for a number of people. The number of uninsured adults in the US has increased to 11.3% in the first quarter of 2017, up from 10.9% in the third and fourth quarters of 2016. Many of those uninsured cannot afford regular health insurance premiums and may not be eligible for coverage under the ACA. Direct primary care (DPC) offers an alternative healthcare practice model for the uninsured. The DPC model operates on patient membership fees, rather than insurance reimbursements. Patients pay a regular monthly fee that may range from $35 to $100, which covers most basic services. Patients may develop a false sense of security, however, in being able to access a range of services for their membership fee. Although DPCs do not generally accept health insurance for their primary care services, DPC physicians often encourage patients to secure catastrophic insurance for services that are not covered in their membership. The preventative care that patients can receive at a DPC practice is crucial to detecting and providing care for potential healthcare issues in the early stages. Most practices include follow-up communication in their services, so patients are able to ask questions or request clarifications outside the office visit. The DPC can play a significant role in early diagnosis and prevention of potentially catastrophic illnesses. When those catastrophic illnesses require additional treatment, though, the costs can be devastating for patients who do not have the appropriate insurance coverage. Patients with chronic conditions, in particular, may require multiple visits with specialty providers and those visits are not covered under their DPC membership fees. DPCs provide a positive alternative to the traditional insurance-based provider. However, DPC should not be considered to be a form of insurance. Rather, the DPC membership fee covers the basic services provided by that particular physician. Catastrophic insurance is generally also recommended by DPCs.

Greg Miller
November 14, 2017

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Does your DPC practice need a practice manager?

The direct primary care (DPC) model is unique because of its financial structure. The DPC practice operates on patient membership fees, rather than per-visit fees or insurance reimbursements. Most independent physicians think of practice management in terms of patient billing and insurance coordination, tasks that are not necessarily a part of the DPC practice. However, there is more to a practice manager’s responsibilities than the financial side; a practice manager can help the DPC practice run efficiently and profitably. As described in a recent post in Physicians Practice, practice managers are “experts in operations management, financial management, human resources management, organizational governance, risk and compliance management, and patient-centered care.” If your DPC practice has staff, which most do, your practice manager can take on the responsibility of managing all of the details of scheduling, payroll, and other HR functions so you can focus on your patients. Physicians Practice also suggests that practice managers can assist the independent physician in a DPC practice with tasks that improve the quality of patient care and reduce costs. Practice managers trained appropriately, for example, can use the practice’s electronic health record (EHR) system to “identify and group patients with chronic diseases and/or conditions, such as diabetes …. to help practices better tailor their treatment approaches and target various patient populations.” Using a practice manager in a DPC practice can help optimize the operations of the practice, giving the independent physician more time to spend with patients. While there may be less – or no – billing involved in a DPC, there are many other functions best left to someone trained in efficient practice management. When searching for a qualified practice manager, keep in mind that ensuring a high quality patient experience is a critical driver for membership-based, direct care practices. Search for staff with excellent communication skills, who can build strong relationships and provide a welcoming front office presence when patients visit the office. Elation Health has published a Direct Care Playbook to answer questions about practice management, marketing, staffing, and many other topics that will help you, as an independent physician operating a DPC, run a successful practice.

Gabby Marquez
November 10, 2017

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What is the difference between an independent physician and a DPC physician?

Physicians face a number of choices, both in their specialty areas as well as their practice structure. A growing number of physicians have chosen to work for hospitals or other larger organizations. However, many have decided they would prefer to become - or remain - independent physicians. Likewise, a relatively new structure is emerging among primary care physicians. The direct primary care (DPC) model is growing in popularity with providers and with patients. What is the difference between the independent physician and the DPC physician? Independent physicians, quite simply, run their own practice. They are autonomous and are not employed by another organization. The independent physician may be a primary care physician or may specialize in a particular field of medicine. Independent practices must be prepared to perform a number of required administrative tasks, including billing and insurance reimbursements. DPC physicians also run their own practice, but they use a different model. The DPC runs on membership fees alone so there are no visit fees to bill or insurance reimbursements to claim. The DPC physician must be prepared to operate solely on those membership fees and may need to negotiate costs with other providers, such as laboratories and radiologists, to be able to remain financially solvent. Since DPC physicians generally do not accept insurance, they will not have the challenges of claims management that independent physicians face. Effective billing practices and collections also tend to become an integral part of an independent practice, particularly for the physician participating in Medicare. DPC physicians may face a different kind of challenge, that of convincing potential patients of the viability of their practice. The DPC model is relatively new and is still not completely understood or accepted by many potential patients. Independent physicians operating in a traditional practice structure will not face this challenge.

Greg Miller
November 2, 2017

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Ideas for Facebook posts for direct primary care practices

Direct primary care (DPC) is a unique and relatively new concept. Many potential patients may have questions about how the practice operates, particularly about the membership fee structure. DPCs function primarily on monthly patient membership fees, rather than depending on insurance reimbursements or visit co-pays. Education and marketing may be necessary to grow a DPC practice, given the potential lack of knowledge and even misunderstandings about this new model of independent physician care. In today’s world of social media activity, one of the best ways to get the word out is through Facebook. Over half of the adults in the United States are on Facebook, so there’s a good chance there will be a great number in your area, viewing information you post on your page on a regular basis. The recommendation is to post several times a week, to be sure your practice has consistent, frequent exposure to patients and potential patients. While that number may be intimidating, there are many great ideas for posting on your DPC’s Facebook page, as suggested by TwineHealth: Fun team photos of your practice staff, with a brief caption. Even better, ask your FB followers to suggest that caption, to keep the post interactive. Health tips. Demonstrate your expertise and help your followers with information about flu shots, vitamins, and other general topics. DPC facts.  Help your followers understand how your practice works and how it benefits them as patients. You can also open up the comment section for questions about DPCs. Patient testimonials. Feature real patients (with their permission) with a brief blurb about why they chose your practice for their healthcare needs. Inspirational quote. Facebook loves inspiring, motivating quotes with appropriate related graphics. Once a week or so, share some uplifting words about healthy bodies and minds. Video of yourself and/or your staff. Facebook provides a feature that enables you to record and post “live” video. Seeing you and your staff in action, so to speak, can reassure potential patients that you have a welcoming practice.

Gabby Marquez
October 30, 2017

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How do direct care and on-site care lower employer spending on healthcare?

An employer that offers healthcare benefits to its employees has a lot of options. Although typically healthcare coverage provided by an employer is focused on traditional insurance plans, alternatives such as funding access to a direct care practice (DPC) or an on-site clinic may prove more beneficial for both employer and its employees. DPCs operate on membership fees. DPC physicians are able to keep their costs lower, because of their reduced overhead expenses, and give more personal attention to each of their patients, as their patient panel is significantly lower than a traditional primary care physician’s would be. Those lower costs translate into lower employer spending, when the DPC is offered as an employee benefit. The basic membership fee covers a range of DPC services, depending on the specific practice. Often the patient is able to access primary care services that include clinical, laboratory, consultative services, care coordination, and comprehensive care management. There are no co-pays, visit fees, or insurance reimbursements involved, which simplifies the process and saves everyone money. On-site clinics operate on a similar principle in that they offer basic services at a cost savings to the employer and the employee. Various studies have shown that when employees have access to - and take advantage of - an on-site clinic, the employer’s healthcare spending is significantly reduced. Those costs savings may be in the form of decreased absenteeism and increased productivity, in addition to the premiums paid to the on-site clinic for employee care. One such study of on-site clinics, published in the The American Journal of Managed Care in 2015, cited the fact that “Regular access to primary care can help curb healthcare costs through increased use of clinical preventive services, reduced hospitalizations, appropriate follow-up of chronic conditions, and greater continuity of care.”

Gabby Marquez
October 26, 2017

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Tips for fitting direct primary care into an employer benefit plan

Direct primary care (DPC) as an employer benefit is a relatively new concept. Employers typically offer traditional healthcare coverage, either fully covered or at a subsidized rate, for employees and their families. With the rise of the DPC model, though, there are a number of ways to fit DPC into an employer benefit plan. More employers are offering high-deductible health insurance plans that are less expensive, in terms of monthly premiums, for both the employee and the employer. With these plans, though, employees pay more out of pocket for basic primary care services. To save money, they may use their healthcare plan primarily for necessary or catastrophic care. The DPC Journal reports that “many of the estimated 30 million people who gained insurance coverage last year (2015) under healthcare reform do not have a primary health care physician or do not use one.” The DPC option gives employees access to primary care services with more focus on the patient-provider relationship, for a membership fee that is usually less than the cost of healthcare premiums. Employers who opt to offer their employees the DPC plan can: Cover the cost of the membership fees for employees just as they would provide the subsidized portion of healthcare premiums Offer employees an allowance that can be used for DPC membership or for another plan of the employee’s choosing Provide a hybrid of available plans, with a DPC option combined with a high deductible plan for catastrophic coverage. DPC practices are becoming more popular, as patients enjoy more direct communication with their primary care physician and the cost savings that accompany a smaller membership fee rather than a monthly insurance premium. Employers who find a way to fit direct primary care into their benefit plan may find that the unique model is more attractive in recruiting potential employees and retaining current employees.

Gabby Marquez
October 17, 2017

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How to decide if the direct care model is right for your practice

The direct primary care (DPC) practice is growing in popularity. Independent physicians enjoy the flexibility and the attention they are able to give each patient. They also generally have less of an administrative burden as their practice is based on patient membership fees rather than insurance reimbursement. Patients enjoy the structure as well, as they have more access to their physician and their membership fees are often less than insurance premiums would be. As an independent physician, you may be considering the transition to a DPC model. How do you know if it is right for your practice? The first consideration is whether your practice can sustain itself through the process. As described in a recent article in Business Insider, when the independent physician moves the practice to the DPC model, it “often means ditching the reliability of a salary.” However, as the practice becomes established as a DPC, “the more patients who sign on, the more money that can be made.” Another consideration when deciding if the direct care model is right for your practice is whether your patients will be willing to switch to the somewhat non-traditional payment structure. Although a full range of primary care services is generally covered under their membership fee, patients also need some form of insurance to cover expenses for additional tests or procedures. Currently, the IRS has determined that DPC patients are ineligible for health savings accounts (HSAs). Patients “can't use the funds from an HSA, flexible savings account, or Medicare savings account to pay their monthly membership bills, explains Business Insider. Your patients will need to understand their options and restrictions in regard to your new practice structure. There are many resources available to you as an independent physician, to determine if the direct care model is right for your practice and to help you manage a DPC practice effectively. Elation Health has published the Direct Care Playbook, written just for independent physicians who want to learn more about the DPC model. The playbook includes sections on marketing and legal issues, as well as tips on optimizing your DPC practice for success.

Greg Miller
October 10, 2017

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How to optimize your DPC practice

The Direct Primary Care (DPC) model is growing in popularity with independent physicians. The DPC practice operates primarily on patient membership fees rather than depending on co-pays or insurance reimbursements. Physicians and patients find the arrangement enables them to enjoy a higher quality of care. DPC physicians generally have fewer administrative duties and fewer patients, giving them more time to spend with their patients. DPCs first started appearing in the late 1990s. By 2016, there were approximately 345 DPC practices in the United States, an increase of 45 over the previous year. Independent physicians are attracted to the financial structure, as they actually incur fewer overhead expenses in the management of their practice. However, the structure also poses some challenges in being able to optimize the practice. Elation’s Direct Care Playbook is written specifically for DPC physicians, to guide them through the many considerations involved in establishing and growing a DPC practice. Running the business side of the practice effectively and efficiently is crucial for a DPC physician to ensure that the practice continues to grow and thrive. The first essential step to optimizing a DPC practice is to set goals and determine success metrics. Even though the basics of the DPC model are relatively simplistic, there are many considerations involved in ensuring that the practice is able to remain financially stable while maintaining a manageable patient panel. Specific metrics and performance indicators to keep track of and build goals for include: Average patient encounter time Number of patients in panel Number of patient visits Patient wait times Average time to an appointment Number of hospital readmissions per patient Tracking progress in relation to these specific and measurable goals is important in optimizing the practice. The DPC physician should analyze the practice’s performance on a regular basis to determine what is working and what needs to be revised. Effective strategies for optimizing a DPC practice include: Delivering a great patient experience Utilizing the care-focused tools within the electronic health record (EHR) system Developing and maintaining a profitable and efficient practice that benefits the physician as well as the patients.

Greg Miller
October 3, 2017

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Best online tools for direct care practices

One of the primary attractions of the direct care practice (DPC) model for independent physicians is that they are able to spend more time with each patient instead of collecting co-pays or billing insurance companies. In a DPC practice, patients pay a membership fee, usually on a monthly basis, which covers all of the basic services provided by the primary care physician. The model is relatively simple, resulting in reduced overhead costs and increased quality time with patients. DPCs do need tools to help them with maintaining patient records, communicating with patients and other providers, and billing for those membership fees, however. Rob Lamberts, MD, offers some suggestions for the best online tools for DPCs, including Elation Health’s electronic health record (EHR) system, which he uses for his practice. Dr. Lamberts states one of his favorite things about the DPC practice model is that he is able to chart “for patient care, not billing,” which to him is “quite liberating.” When choosing online tools for an independent physician’s DPC practice, he recommends looking for: Reasonable cost Ease of input Ease of finding important information In a DPC, the focus is on patient care. An online tool that enables the provider to input and review patient information with one click gives that provider more time spent with each patient. Elations’ EHR solution gives providers what they need to quickly and easily chart visit notes, write prescriptions, and review other providers’ input, including lab results and diagnoses. Before each patient visit, the independent physician using Elation’s EHR has the tools available to stay organized and find information quickly. Notes from the previous visit remain in full view. The provider is able to quickly scroll through the straightforward Chronological Record, or skip to any part, and can search almost anything in the chart. Dr. Lamberts acknowledges that making the move to a DPC practice model can be scary for an independent physician, but “these tools can make that jump a lot less scary.”

Gabby Marquez
October 2, 2017

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Policy recommendations that could enable direct care practices to flourish

Many years ago, healthcare seemed much simpler. A patient saw a doctor, paid the doctor in cash (or made payment arrangements), and that was the end of the financial transaction. In the 1940s, just after the second World War, third party insurance companies came onto the scene, bringing with them paperwork and reimbursements and an array of complexities. Approximately 50 years later, in the late 1990s, a new form of medical care emerged that closely resembled the simpler model from years ago. Direct primary care (DPC) operates on a relatively straightforward model of patient membership fees. Most DPCs do not accept insurance for primary care services but do recommend that patients carry high deductible insurance for services that are not covered by their membership fees. At that point, the complexity re-emerges in regard to current regulations and policies. At present, DPC patients are not eligible for health savings accounts (HSAs). An HSA allows the patient to set aside money, pre-tax, that can be used for healthcare expenses. The account helps patients save for medical expenses, on a pre-tax basis, that would be part of their high deductible insurance policies. A bill has been introduced that would “allow an eligible taxpayer enrolled in a high-deductible health plan to take a tax deduction for cash paid into a health savings account, even if the taxpayer is simultaneously enrolled in a primary care service arrangement.”  However, no action has been taken on the bill to date. In addition, DPC physicians have said that “they'd prefer to recommend catastrophic health insurance plans, which have deductibles as much as $10,000 or $30,000 and aren't allowed under the ACA.” Discussions around proposed replacement healthcare plans may take into consideration these policy recommendations, but that is uncertain at this time. Updating policies and regulations that impact DPC physicians and their patients, to enable them to take advantage of the simplicity and efficiencies the DPC model has to offer, would certainly also enable the direct care practice to flourish.

Greg Miller
September 22, 2017

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Perspectives on direct primary care from DPC physicians

What do physicians think about the direct primary care (DPC) practice model? Given that the model is relatively new in the long history of healthcare services, many physicians are still in startup mode or in the very early stages of their practice operating as a DPC. Several stories have emerged, though, as the concept of the DPC is growing in popularity among primary care providers. Starting a new practice, especially a practice that relies on patient membership fees, can be challenging. Dr. Vance Lassey, who runs Holton Direct Care in Holton, Kansas, told Business Insider that he had to take out a loan and purchase used equipment to get his DPC practice up and running. Four months into it, Dr. Lassey was at a break-even point and, more importantly, was able to spend more time with each of his patients. "I am making a profit, I have more free time, and I can practice properly," he said. "It's worth it to me." Dr. Linnea Meyer has started small as well, in a tiny primary-care practice in downtown Boston. In a recent Wall Street Journal article, she said “Getting that third-party payer out of the room frees me up to focus on patient care.” Dr. Meyer is currently relying on her own savings to fund the practice, but hopes to expand her relatively new practice to 200 patients. “This kind of practice is why I went into medicine, and that feels so good.” Dr. Robert Lamberts, an Elation physician, launched his DPC practice in October 2012 and has been reporting on its progress in Physicians Practice. Dr. Lamberts cites one of the challenges of a DPC practice as being that most patients “still don't understand how paying a monthly fee could bring significant value to their healthcare.” He finds that he and his staff have to explain the concept to skeptical potential patients. However, he says, “two years after making my first patient encounter (as a house call), I am confident that I've found the right way to give care to my patients.”

Gabby Marquez
September 22, 2017

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Frequently asked questions about opening up a direct primary care practice

Independent physicians considering a move to a direct primary care (DPC) practice model probably have a lot of questions. The traditional practice and the DPC model are different in many aspects. The prospect of opening a new DPC practice might actually be a bit intimidating for the independent physician who does not have a clear picture of what is involved. What is DPC? Direct Care is a medical practice model where providers contract directly with patients. The DPC practice operates on patient membership fees that are generally paid on a monthly basis. Some DPC practices do accept insurance payments and many encourage their patients to have insurance coverage for catastrophic events, but the basics of the model depend solely on membership fees. What are some advantages to the DPC model? Patients and providers alike enjoy the benefits of the DPC practice. Providers see fewer patients, enabling the patient to receive more personalized care. Patients have fewer out-of-pocket expenses, as there are no co-pays and no per-visit fees. Most basic services are covered in their membership fees. Providers have less overhead in their practice, as they are not concerned with insurance billing and reimbursement. Are there legal concerns with DPC? Like most medical businesses, direct care practices have legal needs outside of the scope of a physician’s training. Taking advantage of legal help and resources can play a large role in helping the DPC practice comply with laws and employ legal protections. What kind of technology does a DPC physician need? The electronic health record (EHR) is a critical first choice for any physician starting a direct care practice. This tool will be the main technology a physician engages with throughout their day, to keep workflows efficient and inform decisions at the point of care. Is there additional information available? Yes! Elation Health has published the Direct Care Playbook, written just for independent physicians considering the move to a DPC model. The Playbook includes guidance on marketing, staffing, and optimizing the DPC practice for success!

Greg Miller
September 22, 2017

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How to connect and network with other direct primary care physicians

Business people know that networking is the most effective marketing strategy. Meeting and getting to know other professionals, whether in the same industry or in different types of businesses, can help the owner grow in both knowledge and connections. People are more likely to trust - and want to do business with - people they know. This strategy also applies to the direct primary care (DPC) physician. Getting to know other DPC physicians can help you learn and grow in your practice. There are many ways to connect with other DPC physicians, virtually and in person. Elation Health’s Direct Care Playbook offers helpful advice on using social media to reach out to patients as well as to other physicians. When considering the use of social media, such as LinkedIn, Twitter, and Facebook, it’s important to think about what kind of resources and time are needed to commit to such a strategy. Posting timely, relevant content is one way to bring exposure to your practice in the short-term. A more long-term strategy would consist of community building, first defining an audience and devising a strategic plan to engage with this audience over time. When initiating any sort of online communication where patient information may be at risk, physicians should carefully avoid any HIPAA violations. Sensitive situations include posting images of patients without their consent, compromising patient confidentiality by posting identifying information, and communicating with patients via a social media platform. Physicians Practice also advises you to create a relevant profile on social media, including your credentials and a professional photo, and to never offer specific medical advice on these platforms. You might also want to separate your professional pages from personal pages. Of course, in-person connections can be very helpful to you as well. In-person connections can be made by joining professional associations and attending events such as conferences. Research organizations that meet in your area as well as those with events scheduled across the country. When attending these events, have an open mind about the connections you will make. You never know who you might meet that you can help or who can help you in your practice!

Greg Miller
September 22, 2017

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Marketing for direct primary care (DPC) practices

The Direct Primary Care (DPC) practice model is still relatively new. With a payment structure that is completely different than the insurance-focused traditional practice, new DPCs may have to market their practice to build their patient panels. Part of the attraction of the DPC, of course, is for the independent physician to be able to see fewer patients than in a traditional practice; however, patients do still have to be attracted to the DPC for it to be successful. Education may be the first challenge and the primary strategy in a DPC’s marketing efforts. The Wall Street Journal reports that “less than 2% of the nation’s 900,000 licensed physicians are involved in direct primary care to date” (as of February 2017). The concept is new and many patients might be hesitant when it sounds like too good a deal. A patient may pay as little as $60 a month for complete access to the primary care provider, including communication during and between visits, with no co-pays or deductibles. A DPC’s marketing efforts will need to educate potential patients on the value, and possibly the legitimacy, of the structure. One excellent way to promote the practice is through word-of-mouth. Patient referrals are hands-down the best way to market a practice as well as an excellent way to educate and reassure potential patients. Testimonials from those patients who have taken advantage of the DPC structure and enjoy the results they are seeing from it will do more to market the practice than any amount of paid advertising. Effective patient engagement within the practice will become a popular topic for testimonials, spread through word-of-mouth and posted on the practice website. Social media posts can also help market the practice. Again, having current patients help spread the word through social media can reinforce the trustworthiness of the message. Building a low-cost marketing plan into a DPC’s practice management plan can be as easy as providing quality care to current patients and asking them to help spread the word.

Gabby Marquez
September 19, 2017

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Useful direct primary care websites and resources

The direct primary care (DPC) model can create questions for both the patient and physician. Whether an independent physician is just starting up a DPC practice or searching for guidance and information for an established practice, it’s helpful to have available resources to turn to for answers and direction. There are a number of helpful websites that either provide that information or list additional resources, such as scholarly articles and books. The American Academy of Family Physicians (AAFP) lists a Frequently Asked Questions (FAQ) page on DPCs, providing straightforward answers as well as a list of References at the bottom of the page. The site discusses the basics of the DPC structure and answers questions about insurance and Medicare in relation to the DPC model. New England Direct Primary Care provides resources for physicians and for patients on its site. It also features a page of information and answers for employers, regarding the DPC model. The site lists resources for physicians transitioning to a DPC practice, including a brief overview of regulatory issues, and lists Elation Health as a DPC-friendly electronic health record provider. Direct Care West provides resources that includes websites and blogs, podcasts, and books. Direct Care West is a student-led organization, dedicated to helping medical students and residents, but which also has a number of very helpful resources listed for seasoned physicians wanting to learn more about the DPC model. Elation Health also provides a number of resources for physicians interested in learning more about the DPC practice model. We have published a Direct Care Playbook for those independent physicians who are considering launching or transitioning their current practice to the DPC model. The Playbook offers guidance on marketing, legal concerns, and staffing, to help physicians optimize their practice for success. The Elation Direct Care and Concierge Medicine Blog provides the latest news and updates to help independent physicians who want to learn more about the DPC model. In this blog series, we explore the many aspects of launching and operating a successful DPC practice, with the goal of helping independent physicians and their patients become more knowledgeable about this unique practice model.

Gabby Marquez
September 18, 2017

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What are some myths about direct primary care?

The direct primary care (DPC) model for a physician’s practice continues to be misunderstood, even though the number of DPC practices continues to increase. Among patients and potential patients, a number of myths continue to be circulated despite the popularity of the DPC model. Several myths also permeate the healthcare industry itself. Myth: As independent physicians continue to move to the DPC model, which typically results in a reduced patient panel size, the primary care physician shortage will worsen. The American Academy of Family Physicians (AAFP) addresses this myth by pointing out that physician burnout more typically contributes to the physician shortage situation. Physicians who are only able to spend a few minutes with each patient, because they have so many patients to see in a day, become stressed and worn out. The DPC structure enables physicians to spend more time with each patient, which increases patient engagement and decreases provider burnout. Myth: It’s too good to be true. There must be hidden costs for the patient. The financial structure of a DPC enables independent physicians to provide quality care for their patients at a reduced cost. There are no co-pays or per-visit fees, so there is less involved in managing the practice’s administrative tasks. Most DPCs do not take insurance either, so the burden of billing and waiting for approval and reimbursement is eliminated. The patient’s membership fee covers all basic services and many additional lab tests and procedures. Myth: The physician will not be available to the patient as much as in a traditional practice. Twine Health comments upon and addresses this baffling myth. The fact is, independent physicians in a DPC model practice spend much more time with each patient. Communication is enhanced during longer patient visits and in follow-up availability. Patients are encouraged to contact their provider with questions and concerns in between visits as well. The DPC model has been around for a number of years, yet the myths continue primarily because of a unique structure that is not dependent on insurance company approval or reimbursement. A practice in which the primary care provider has significantly more time to spend with patient and that does not collect payments at each visit may well be too good to believe for some patients - and even some providers!

Gabby Marquez
September 18, 2017

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How to ensure your direct primary care (DPC) practice is sustainable

The innovative direct primary care (DPC) model can be enticing as well as a bit intimidating, for both independent physicians and patients. DPC practices are essentially self-sustaining, financially, as most rely solely on patient membership fees and do not accept insurance payments. While this may sound appealing to independent physicians who are frustrated with the process of submitting claims and waiting for payments, it can also be challenging, at least at first, to sustain a practice on membership fees alone. Dr. Rob Lamberts, writing in Physicians Practice, talks about his experience in making “the jump” from a traditional practice to the DPC model several years ago. Dr. Lamberts, who uses Elation technology successfully in his DPC practice, writes that it was not easy getting to the point in his practice where he is able to pay himself a reasonable salary while improving his quality of life and the quality of care he is able to give his smaller patient base. Dr. Lamberts offers three tips for those independent physicians who are just starting up in a DPC practice, to help them ensure that their practice is sustainable: Have a vision. Focus on the need to provide quality healthcare, to build positive relationships with patients, and to give patients individualized attention. Dr. Lamberts states that having “a much better relationship with my patients was enough of a salve to put up with small balances in my bank accounts.” Get your staff to share your vision. DPCs tend to have smaller staffs, as the need for administrative help is reduced. With a smaller staff, it is actually easier to ensure that everyone shares the same vision. When your staff has that same vision and purpose in mind, “you not only have less to worry about, but you have a huge ally as you build your practice.” Set your prices right. Ironically, DPCs that fail early on tend to charge too much. The fear of not having enough income to sustain the practice may cause the independent physician to try to generate more cash flow too quickly and that will backfire. Dr. Lamberts advises DPC providers that “the ideal customer is one who has low demand and high satisfaction with the product you offer.” Finally, Dr. Lamberts says that for the independent physician considering making the move to the DPC model, “there has to be a certain level of belief in what you are doing, as well as a willingness to go through some lean times to find that gold at the end of the rainbow.”

Greg Miller
September 18, 2017

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Florida legislature considers direct primary care bill

The direct primary care (DPC) practice model virtually eliminates insurance from the patient-physician relationship. DPC practices are sustained through patient membership fees rather than through insurance reimbursements or per-visit fees. The model is relatively simplistic but creates a number of complications when it comes to healthcare regulations and legal considerations. The state of Florida is in the process of considering, once again, a bill regarding the DPC practice model. A similar bill was passed by the House in the spring of 2017 but stalled in the Senate. That bill identified a number of protections for the patient as well as for the DPC practice. According to the SunSentinel, the spring bill specified that “primary care agreements be in writing, signed by both patients and providers, allow either party to terminate the agreement by giving at least 30 days advance notice, and state that the agreement is not health insurance and that providers will not file claims against the patient’s health insurance policy.” The agreements for DPC patients and providers would also clarify the patient membership fees and what would be covered under those fees. DPC fees typically range from $50 to $100 a month. Some DPC practices have adjusted fees for very young or elderly patients. Patient membership fees generally cover basic services provided by the physician but may also include lab tests or procedures. The new bill, introduced in August 2017 for the January 2018 legislative session and supported by physicians as well as small businesses, “would make clear that the agreements are not insurance and are not subject to regulation under insurance laws,” according to WUSF News. Elation Health supports the DPC model with our electronic health record (EHR) solution and helpful articles focused on the DPC practice. We have also prepared a helpful guidebook for independent physicians considering the DPC model for their practice. Elation’s Direct Care Playbook contains sections on legal considerations, marketing tips, staffing guidance, and optimizing the practice for success.

Gabby Marquez
September 8, 2017

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Reasons why PCPs are switching to concierge medicine

Concierge medicine has traditionally been a practice model associated primarily with the wealthy. Concierge patients pay a membership fee, generally in the range of $150-200 per month, in addition to their health insurance premiums. In return, they receive personal service, often including house calls and unlimited communication with their physician. The concept of concierge medicine, however, is shifting and is becoming more popular among patients as well as primary care physicians. A Forbes contributor, Russ Alan Prince, recently wrote about a survey conducted of 114 primary care physicians who had converted their practices to the concierge model. The research found a number of reasons for the switch. Almost 90% of the survey respondents said they made the switch to concierge medicine because the practice model enabled them to provide that patient-focused service, “without being constrained by bureaucratic or insurance related obstacles.” Although concierge practices do accept insurance payments in addition to patient membership fees, it is the membership fees that truly keep the practice solvent. Those financial considerations were the second-ranked reason given by the primary care physicians who switched to the concierge medicine model in their practice. The patient membership fees are often used as a reinvestment in the practice. Using membership fees to support the practice alleviates the challenges often faced when dealing with insurance companies and waiting for reimbursement. Patient engagement, however, is the main focus of the concierge medicine model. Primary care physicians who want to be able to give their patients more attention than their paperwork are increasingly moving toward non-traditional practice models, such as concierge medicine. Elation Health’s goal is also to help independent primary care providers focus on their patients. To that end, we are committed to our mission of strengthening the relationship between patients and physicians and enabling phenomenal care for everyone.

Greg Miller
September 8, 2017

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Why direct primary care is here to stay

When the pioneering direct primary care (DPC) practice, Qliance, closed in June 2017, many saw it as a sign that the DPC model was failing. Qliance, founded and backed financially by Amazon founder Jeff Bezos, TV personality Drew Carey and computer mogul Michael Dell, shut down somewhat suddenly. A notice posted on their website offered an official reason that it was “unable to find the bridge funding needed to help us maintain our operations until new contracts could take hold.” The closure of Qliance, after serving approximately 13,000 patients in the Seattle region for the past ten years, has made many in the healthcare industry wonder whether DPCs can sustain themselves financially. After all, if a project backed by Bezos, Carey, and Dell can’t survive, what chance do other, smaller practices have? However, the closing of Qliance was probably due more to financial problems outside the practice model, rather than not being able to sustain the practice based on patient membership fees. According to Geekwire, Qliance co-founder and CEO Erika Bliss told them that “that the company’s lender made an ‘unauthorized withdrawal’ of about $200,000 from a Qliance bank account on May 12, causing the sudden shutdown.” DPC is not only here to stay, the model is actually growing in popularity. As KevinMD reports, the idea that the closing of Qliance “means certain collapse and failure of the direct primary care movement is nonsensical.” Interest in the unique model of a DPC practice is, in fact, growing among independent physicians and their patients. There are many resources available to help DPC practices. The American Academy of Family Physicians (AAFP) has formed a special Member Interest Group dedicated to DPCs, a group that is increasing its participation among AAFP members. In addition, Elation Health has just published a Direct Care Playbook, written specifically to help independent physicians considering establishing new DPC practices. In 2005, there were fewer than 150 physicians practicing in direct primary care, concierge, and other direct care models. This number grew 5x in the next five years, to 756 in 2010, and then even more rapidly to an estimated 6,500 direct care physicians across the country by the end of 2015. Elation Health is dedicated to providing the resources direct care physicians need to continue to grow and prosper while providing quality, affordable healthcare to their patients.

Greg Miller
August 29, 2017

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How does the DPC model work?

In an environment of uncertainty around healthcare coverage and insurance plans, many physicians and patients are taking advantage of a different option. Direct primary care (DPC) offers benefits to independent physicians and their patients, mostly without involving insurance companies. Business Insider says the DPC model “could be the future of medicine.” DPC physicians are able to see fewer patients during the day and spend more time with each patient. However, the Wall Street Journal says the model “could exacerbate the shortage of primary-care doctors.” How does the DPC model work? Essentially patients pay a membership or retainer fee, on a monthly, quarterly, or yearly basis. The fee covers almost all primary care services including clinical, laboratory, consultative services, care coordination and comprehensive care management. In addition to direct care, many patients elect to acquire a high-deductible wraparound policy to cover the emergency care that is not covered under direct care. The Wall Street Journal adds that “proponents say the direct-primary-care model may work particularly well for patients with complex medical conditions who need careful monitoring and help coordinating multiple specialists.” Patients are not charged a per-visit fee or co-pay and are able to communicate with their physician whenever they have questions beyond the visit. Elation’s Direct Care Playbook offers helpful information and guidance for those independent physicians interested in pursuing the DPC model option. Physicians and patients are discovering the benefits of the model in increasing numbers. In 2005, there were fewer than 150 physicians practicing in direct primary care, concierge, and other direct care models.  This number grew 5x in the next five years, to 756 in 2010, and then even more rapidly to an estimated 6,500 direct care physicians across the country by the end of 2015. Patients in a DPC practice benefit from longer visit times with their physician. DPC physicians tout the model as providing them the opportunity to do what they went into medicine to do, to focus more on their patients’ health and less on administrative burdens.

Gabby Marquez
August 25, 2017

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Rising direct primary care practices

Independent primary care providers are passionate about providing quality care to their patients. They enjoy the interaction with their patients and seek to enhance the provider-patient relationship. One way they’ve found to increase the time they are able to spend with each patient is to transform their practice into a Direct Primary Care (DPC) practice. Patient engagement is very important to physicians like Dr. Garrison Bliss and Dr. Ken Rictor. Both use the Elation EHR tool to further optimize their practice management and to maintain accurate patient data that is accessible seamlessly and securely. They have each launched a DPC with the goal of spending more time with patients and less time on administrative duties, which is made even easier as they take advantage of the Elation EHR. Dr. Rictor has been practicing medicine for almost 30 years. In 2014, he transitioned his practice to a DPC to maximize the quantity and quality of time he’s able to dedicate to his panel. Recognizing the need for a solid data management system, Dr. Rictor tried a number of different EHRs, but ultimately found Elation to be the best fit for his DPC practice. He found the tool to be intuitive, saying “as soon as I opened up the Elation home screen I know exactly where I need to go and what I need to do.” Dr. Bliss, considered to be the “godfather of direct primary care and a nationally respected Internal Medicine physician in Seattle, Washington,” began using the Elation EHR in 2015. In his DPC practice, he has a patient panel of just over 400 patients, and is focused on building intimate and meaningful relationships with each of them. Dr. Bliss has been particularly impressed with Elation’s assistance in the migration of his data to his new EHR system and with the user-friendly provider screens and patient portal. Elation is excited to help independent physicians like Dr. Bliss and Dr. Rictor, as they focus on providing the highest quality healthcare to their patients.

Gabby Marquez
August 25, 2017

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What is concierge medicine?

The patient with traditional health care coverage usually pays a monthly premium and then a co-pay at each primary care provider visit. There are usually higher co-pays for specialty provider visits and perhaps even deductibles for hospitals or other healthcare facilities. For the provider, these plans involve billing and then waiting for reimbursements from insurance companies, on which they are dependent for their financial solvency. There are options to these traditional plans. One of the options is concierge medicine. Although concierge medicine is based on a concept that is anything but new - providing personal service to a small group of patients - the formal structure has been around for just over 20 years. In concierge medicine, the patient pays a set monthly fee, which can range from a few hundred dollars to several thousand. For that fee, the patient is covered for primary care provider visits as well as a list of other services. The patient is generally able to schedule same-day appointments and receives personal care based on an enhanced provider-patient relationship. For the provider, concierge medicine offers: Smaller patient base. Concierge practices typically are able to maintain smaller groups of patients, providing each patient with more personal service. Predictable monthly fee. Instead of relying on fees billed per visit, the concierge physician can be assured of a steady stream of income from patients’ monthly fees. Access to patient-provider communication. With a smaller patient base, communication happens more frequently and more quickly, so questions can be answered and care instructions can be conveyed more efficiently. Limited insurance company interactions. Many patients in concierge care may continue to carry insurance coverage. However, the concierge provider does not rely on those reimbursements but rather bills insurance as a convenience for patients. Concierge medicine is still a small part of independent physician practices but is growing at a rate of about 5% to 6% annually across the country.

Greg Miller
August 25, 2017

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The pros and cons of launching a hybrid DPC clinic

The direct primary care (DPC) model is a unique structure. There are no co-pays or per-visit fees. Patients pay a membership fee, either on a monthly or an annual basis that covers all of their basic services at the primary care provider’s office. Some DPC practices include lab tests and other services as part of the membership fee. Typically, the DPC does not accept insurance so has reduced overhead and lower costs that are then passed on to the patients. A DPC provider may encourage patients to secure a high-deductible insurance plan to cover catastrophic services not included in their membership fee. Making the move from a traditional practice to a DPC can be challenging for an independent physician. The financial health of the practice must be managed appropriately to survive the transition. Many primary care providers opt to move to a hybrid DPC model at first. A hybrid model is one in which providers has some patients on a membership fee and some patients on insurance plans. Financially, the hybrid can help independent physicians transition to a full DPC model. As Lee S. Gross, MD, Co-Founder of Epiphany Health Direct Primary Care, stated in an article recently, the hybrid model “allowed us to test and troubleshoot the model, add an additional steady revenue stream to our established practice, and gradually transition away from third parties on our own schedule.” However, an article in Twine Health points out that there are many complications in the hybrid model that may not make it a good choice for that transition. One of the more serious challenges is with regulatory issues, particularly when trying to balance insurance payments and membership fees. A simple billing mistake could create big trouble with industry regulators. Elation Health is committed to helping independent providers understand more about the DPC model. We have launched a blog series specifically designed to provide independent physicians the information they need on direct primary care and concierge practices.

Gabby Marquez
August 24, 2017

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Strategies for scaling up your direct primary care practice

The direct primary care (DPC) practice model is innovative and unique. In today’s unsettled healthcare policy environment, a DPC is even more attractive to both the independent physician and patients. In a DPC practice, the physician is not overly burdened by administrative tasks but can actually spend more time focusing on the patient’s needs. The DPC patient does not have to worry about co-pays or per-visit fees, as nearly all basic services are covered under a monthly or yearly membership fee. Making the move to a DPC model can be challenging, however, as the need for financial stability continues even as the method and frequency of income shifts to those membership fees. How can the independent physician continue to grow a DPC practice? Spread the word! Using social media to inform new patients about the structure and benefits of the DPC model - and about the features of the independent physician’s particular practice - can contribute to a growth in the physician’s patient panel. Many potential patients may not understand how a DPC works. It actually may sound too good to be true. Bits of information distributed via social media can encourage those patients to give it a try. Learn from others. The DPC provider can learn a lot by networking with other DPC providers, joining a shared interest group online, or attending events such as the Direct Primary Care (DPC) Summit. The 2017 summit, for example, “offered guidance for physicians who might be considering the innovative practice model but are unsure how to proceed.” Take advantage of technology. The independent physician who uses electronic health records (EHRs) for tracking and managing patient data, communicating with patients and other providers, and identifying patients who aren’t meeting goals will have an advantage in developing a reputation as a physician who focuses first and foremost on patient outcomes.

Gabby Marquez
August 24, 2017

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Marketing your direct primary care practice to employers

The number of self-funded employers is growing. These employers take on the financial responsibility of providing healthcare to their employees, eliminating the middlemen of insurance companies, so they are typically looking for ways to save on costs. Just as a direct primary care (DPC) practice can save patients money, it can also be the answer for these self-funded employers. How do you market your DPC practice to employers? Physicians Practice suggests a basic, three-step process that will help you engage potential employees with your DPC message: Do the research. Who are the self-funded employers in your area? Databases are available that provide the business name and, generally, the contact person at that business. A good place to start the research is the Self-Funding Association. Understand what employers need. Create a healthcare services plan that makes sense to them and their employees. Do they have younger employees with children who need frequent well checks? Are they looking for cost savings in primary care services specifically? Will they need additional services such as lab tests? Emphasize the technology your practice uses, including electronic health records (EHRs), that enables you to provide more cost-efficient services while focusing on the quality of your patients’ care. In your plan, include the capabilities you offer your patients to communicate with you in a safe, secure environment as well as your abilities to coordinate care with specialty providers. Contact employers and present what you have to offer as a DPC. Using the contact information you discovered in your research, reach out to employers with a letter stating the benefits you offer them and their employees as a DPC. Physicians Practice recommends keeping the initial contact simple: “A friendly, typed letter detailing your program, services or even just your desire to explore options should generate a call back.” Elation Health has created a helpful Direct Care Playbook that can also help you market your DPC practice to potential new patients.

Greg Miller
August 21, 2017

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Shopping list for new direct primary care practices

Many independent physicians are joining a trend toward a type of practice that allows them to spend more time with patients and less time with insurance companies. The Direct Primary Care (DPC) model operates on patient “membership fees” rather than per-visit fees. Those monthly fees paid by patients give them access to the provider in the office and beyond the visit, as well as a range of additional services, with no co-pay or deductible. Are you ready to start your own DPC practice? Do you know what you will need to purchase before you open your doors? You will, of course, need an office for patient visits. You will also need to fill that office with the appropriate furniture and medical equipment necessary for seeing and treating those patients. The number of patients you will see in a DPC practice will typically be lower than in a traditional physician’s office. Therefore, your actual physical space may be smaller. You will need a few chairs for your waiting room and a desk for patient check-ins. For patient privacy purposes, the desk should be sufficiently separated from the waiting area. You may have one or two exam rooms that will require a couple of chairs and an examination table. You will also need cabinets that can be locked to store supplies. While all of this may sound like an expensive purchase, many DPC physicians, like Dr. Vance Lassey, who runs Holton Direct Care in Holton, Kansas, have found inexpensive equipment and furniture at surplus stores or hospitals. Of course, to run an efficient DPC practice, you will also need an effective electronic health record (EHR) system that enables you to maintain your patients’ records, access visit notes quickly and efficiently, and communicate with patients in a secure manner. Add to your shopping list the computers necessary to input and maintain patient data and you’re on your way!

Greg Miller
August 17, 2017

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Technology that can help your direct primary care practice

Direct Primary Care (DPC) practices operate on the premise that the physician wants to be able to spend more time with patients and less time filling out paperwork or dealing with insurance companies. The American Academy of Family Physicians (AAFP) reports a “a number of reported outcomes of increasing visit time, including improved patient experience of care and improved clinical outcomes as patients become more engaged in managing their own health care.” Such patient-focused practices will benefit from the appropriate technology. Direct care physicians actually tend to be heavy users of technology in their practices, due to the demands of retaining patient memberships. Practices need access to a wide-range of technology and services, from patient marketing platforms to labs and imaging services. Which technology is optimized for and best suited to meet the needs of direct care practices? The electronic health record (EHR) is a critical first choice for any physician starting a direct care practice. This tool will be the main technology a physician engages with throughout their day. The EHR is used to keep workflows efficient and inform decisions at the point of care. Patient data is securely stored and easily accessible on an EHR as are other functions that can help the DPC provider manage his patients and his practice more efficiently. Secondary tools that can integrate with an EHR include but are not limited to membership management platforms, data integration tools, in-office dispensing software and suppliers, specialty consultation software, financial tools, and communication platforms. Communication is a significant attraction for patients and physicians alike in a DPC model. Patients enjoy the ability to send messages, ask questions, and receive additional instructions via electronic communication available to them around the clock. The physician also needs an effective tool for exchanging information with other providers when coordinating care for their patients. Technology can help the DPC practice in many areas, and can help the independent physician stay focused on quality patient care.

Gabby Marquez
August 16, 2017

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Pricing considerations for direct primary care practices

As an independent physician, the idea of moving to a direct primary care (DPC) model can be intriguing. The model involves patient payments that are made through membership fees rather than per-visit charges. Typically, the patient panel size is also smaller for DPC providers. Many DPC providers do not accept insurance or bill insurance only as a convenience to patients. In the DPC model, administrative tasks involved in practice management are reduced and time spent with each patient is increased. When a primary care provider decides to operate under a DPC model, however, decisions also have to be made about the pricing structure for the practice. Since there are no co-pays or visit fees, the practice’s membership fees are the primary income and so must be considered with care. The American Academy of Family Physicians (AAFP) states that “nearly 50% of a family physician’s workday is spent outside of face-to-face visits, often in conducting vital follow-up or helping to coordinate care for patients as they communicate with other clinical providers.” In a DPC model, those additional costs can be covered with the appropriate membership fee. Elation Health has created a Direct Care Playbook, specifically to help independent physicians with DPC considerations such as pricing. The Playbook provides the following guidance on how to handle pricing for a new DPC practice: Setting per-patient pricing is a key final step in setting up your practice. Membership fees range widely and can vary on an individual and family basis. Accounting for age, geography, and local patient demographics are all key inputs to effective pricing strategy. Direct care physicians also need to decide how much they need to make to keep their practice afloat, and how much they would like to make in an ideal situation. This calculation can be accomplished taking: Sum all expenses (salaries, office space, and all other operating expenses) Divide by anticipated size of the patient panel Assume a baseline of 300-500 patients per physician as an average panel size. This calculation will give a practice a break-even price point, and the physician can then consider desired take home pay as a final input in setting pricing for their practice.

Greg Miller
August 8, 2017

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Social media for DPC physicians

Direct Primary Care (DPC) physicians can use a number of marketing tools for promoting their practice and for educating patients. DPC is a relatively new concept and a DPC practice may need to clarify some information or provide additional details regarding the way the practice operates, to reassure potential and current patients. Social media can be an effective platform for reaching those patients. Millennials and Gen Zers, those patients in their mid to late 20s and younger, use social media as their primary means of gathering and sharing information. As millennials are approaching their 30s, they are getting married and starting families. A DPC practice that wants to attract this younger and largest generation of patients will need to have a solid social media presence. Care must be taken when implementing a social media strategy. Online posts can take on a life of their own, with shares and reposts. A DPC’s messages must be professional and appropriate. When initiating online communication where patient information may be at risk, physicians should carefully avoid any HIPAA violations. Sensitive situations include posting images of patients without their consent, compromising patient confidentiality by posting identifying information, and communicating with patients via a social media platform. DPC physicians should make use of their electronic health record EHR capabilities when communicating with patients, to ensure that any information transmitted is secure. Social media can reach a large number of people with just one post, but that one post requires careful planning and a bit of effort on the DPC’s part. A staff person may be assigned to post timely, relevant content and to respond to comments. For example, a DPC practice may decide to build a Facebook page that will require timely and consistent monitoring. These social media options do provide the DPC with an effective outlet for education and marketing, as long as they are planned and maintained in a manner that is engaging and professional.

Gabby Marquez
August 3, 2017

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Direct Primary Care and health savings accounts

The direct primary care (DPC) model has benefits for both independent physicians and their patients. DPC practices are run on membership fees, so there is less administrative work for the provider and fewer out-of-pocket costs for patients. Some DPCs do accept insurance, primarily as a convenience for their patients and to cover procedures or hospitalizations that are not included in the membership fees. In the eyes of the Internal Revenue Service (IRS), however, the membership fees are themselves are not a form of insurance and so patients are not allowed to use Health Savings Accounts (HSAs) to pay those fees. A bill has been introduced that would revise the IRS ruling. H.R.365 - Primary Care Enhancement Act of 2017 was introduced into the House in January 2017. The bill would amend the IRS code to “permit an individual to pay primary care service arrangement costs from a health savings account.” In addition, H.R. 365 would “allow an eligible taxpayer enrolled in a high-deductible health plan to take a tax deduction for cash paid into a health savings account, even if the taxpayer is simultaneously enrolled in a primary care service arrangement.” The bill expands the definition of “medical care” to “include periodic provider fees paid to a primary care physician for a defined set of medical services provided on an as-needed basis.” The bill was referred to the House Committee on Ways and Means on January 6, 2017, but no further action has been taken since. DPCs enable independent physicians to more actively engage with their patients, as they generally see fewer patients and are less concerned with the paperwork involved in dealing with insurance companies. The independent physician in a DPC practice must balance the financial structure with the benefits involved for both provider and patients. Elation Health is dedicated to helping DPC physicians succeed. We offer an electronic health record (EHR) system that aligns with the unique goals of a DPC practice. We have also just released our Direct Care Playbook, written specifically to help independent physicians in a DPC launch and sustain a successful practice.

Gabby Marquez
July 31, 2017

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What are the first steps to take for starting a DPC practice?

The direct primary care (DPC) model is enticing to many independent physicians. The number of DPC practices continues to grow, with the lure of reduced administrative burden and increased patient interaction time. Independent physicians who decide to practice under the DPC model may be starting completely new practices or transforming an existing traditional practice. Either way, there are some steps that should be taken when starting a DPC practice. The American Academy of Family Physicians (AAFP) recommends that the independent physician with an existing practice should conduct “a practice evaluation to determine whether the practice would benefit from transforming into a DPC practice.” Once that is done, the AAFP recommends consulting a legal expert familiar with DPCs who can provide “insight about local and state regulations governing the practice of retainer-based medicine and whether current insurance carrier contracts may be amendable to complementary services covered under a retainer fee.” Elation Health has developed a Direct Care Playbook that outlines steps that need to be taken by a physician considering launching a new DPC practice.  Some considerations include: Finding an office. The physician will need to determine whether it is more feasible to rent or buy office space. The office will also need to have equipment and furniture. All of these steps will take time, generally about six months. Staffing. With the DPC structure, the number of staff required to manage the practice is significantly reduced but the physician will probably need one or two assistants for the practice. Pricing guide. Since a DPC practice operates primarily on patient membership fees, DPC physicians need to decide how much they need to make to keep their practice afloat, and how much they would like to make in an ideal situation. The DPC physician will also need reliable technology to maintain patient records. The electronic health record (EHR) is a critical first choice for any physician starting a direct care practice. This tool will be the main technology a physician engages with throughout the day, keeping workflows efficient and informing decisions at the point of care.

Austin De La Ossa
July 31, 2017

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Legal tips for direct primary care practices

A direct primary care (DPC) practice operates differently than a traditional independent provider’s practice, in regard to how it affects both the patient and the physician. A DPC practice, at first glance, appears to have a relatively simple model. The practice receives monthly membership fees from patients rather than charging for each visit. These membership fees cover basic primary care services and may, depending on the practice, also cover a number of coordinated care and off-site laboratory or diagnostic services. The idea behind DPC is that physicians are able to spend more time with their patients and less time worrying about billing, insurance, and practice management. DPCs may or may not accept insurance. Those who do, bill the insurance company as a convenience for their patients or to cover services and procedures not included in their monthly fees. Some also accept Medicare payments. That is where the simple idea behind the DPC starts to get a little more complicated. However, physicians practicing under any type of DPC model, hybrid or not, do have some legal considerations. The American Academy of Family Physicians (AAFP) recommends consulting with an attorney familiar with the DPC model who can provide “insight about local and state regulations governing the practice of retainer-based medicine and whether current insurance carrier contracts may be amendable to complementary services covered under a retainer fee.” Elation’s Direct Care Playbook offers some helpful legal tips for DPC practices as well. Review and secure appropriate malpractice insurance. Independent physicians who move to a DPC model may be able to save money on malpractice insurance. DPC physicians tend to have fewer claims than regular physicians, so they can receive a nearly 50% discount on the cost of their malpractice insurance. With significantly lower malpractice premiums, direct care physicians can more easily obtain such insurance to protect their practices against potentially damaging lawsuits. Review IRS regulations and definitions. Currently, the DPC practice patient fee is not a qualified HSA expense. Likewise, even though Medicare patients are the nation’s highest utilizers of care, most are unable to receive direct care, unless they receive coverage under a Medicare Managed Care Plan. Elation also strongly recommends that the DPC practice consult a lawyer to ensure that the physician is up to date on the latest policies and procedures that affect the practice as well as the patients.

Greg Miller
July 31, 2017

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Building a website for your direct primary care (DPC) practice

As a direct primary care (DPC) physician, your focus is on taking care of your patients during their visits to your office. To grow your practice, you will also need a way to reach out to potential patients. As a DPC provider concerned with your patients’ health and well-being, you may also want to find a way to continuously educate them about your practice and about healthcare in general. A website can do all these things for your practice. Establishing an online presence through a professionally designed and maintained website can help your practice build credibility and provide information in an accessible format. In particular, a well-designed and responsive website will help your practice stand out from the crowd. Here are some key elements your website should include: Contact page with location and hours of operation About us page to tell your story Testimonials to showcase the care you provide Practice blog to help attract new patients Services page to communicate what you offer As a DPC with standard monthly fees, you might also decide to post those fees on your website. All of these pages should contain specific keywords that will attract search engines and attract those patients who are searching for the types of services you offer. Your site should be compatible with mobile devices, as most of the younger generations, millennials and Gen Zers, as well as a number of older Boomers, depend on their cellphones and other electronic devices for accessing important information. Search engines are also more likely to rank a mobile-friendly site higher. Likewise, your website needs to be easy to navigate so visitors can find the information they need quickly and effortlessly. A website needs to engage patients with pertinent and current information about your practice and about healthcare topics in general, in order to attract new patients and to keep current patients educated.

Austin De La Ossa
July 28, 2017

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5 new direct primary care clinics to look out for

Direct primary care (DPC) practices are on the rise, with a number of independent physicians realizing they want to spend more time with their patients and less time billing insurance companies. The DPC model typically charges patients monthly fees, rather than fees for each visit, and they generally do not work with insurance companies. The patient receives services from the primary care provider, including virtually round-the-clock communications access and occasionally house calls, for their monthly payment. Five new DPC clinics have sprung up from the providers’ desire to focus more on patient outcomes than on administrative tasks. Dr. Dhillip Olshausen, in Medford, Oregon, says that “direct primary care allows the doctor to be a doctor again.” He is transitioning his traditional practice, in which he estimates he and his staff spent 50% of their time on administration, to a DPC in July 2017. He, his staff, and his patients are looking forward to developing a closer patient-provider relationship as he focuses more on healthcare delivery and less on paperwork. Iora Health intends to collect its DPC fee from employers for a new form of healthcare coverage for their employees. Iora has entered into a contract with UniCare in the state of Massachusetts, which will “pay Iora a monthly amount per-member, ultimately lowering the bill for the state by caring for patients on a budget.” Gold Standard Pediatrics launched in South Carolina in late 2016, “with the singular focus of providing the highest quality personalized medical care for children.” Gold Standard’s goals are to help families find affordable, quality care for their children. In Alabama, Dr. M. Chad Williamson recently opened his DPC practice to spend more time with patients and less time with insurance companies. His pricing is listed on the practice’s website and includes discounts for military, police officers, and firefighters. Dr. Williamson also offers a membership rate of $1 annually to patients aged 100 and above! Making the move to a DPC practice from a large medical group last year, Dr. David Cunningham launched Infinity Family Care in Mansfield, Massachusetts. Dr. Cunningham offers a special membership plan for home-bound patients, setting his practice apart from the traditional office-bound independent physician.

Gabby Marquez
July 27, 2017

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Tips for staffing for DPC practices

Direct primary care (DPC) practices typically see fewer patients than a traditional practice. A DPC usually also opts to not accept patient insurance. As a result, overhead for a DPC is significantly reduced, overhead that includes staff members. When the practice does not bill per visit or bill for insurance reimbursement, there is less need for people to perform these duties. The DPC does bill for monthly membership fees but will generally not require the typical fully staffed office found in an independent physician’s practice. A DPC physician who wants to attract staff to the practice should keep a few things in mind. With a smaller staff, it is even more important that the people working in the practice are able to work as a team. Owen Dahl, writing in Physicians Practice, suggests that potential staff should be evaluated based on three factors: Knowledge. A DPC’s staff must be knowledgeable not only of how the DPC practice operates, but may also need medical knowledge, to be able to assist the primary care provider with patient engagement and care. Skills. Although there is less to do in regard to billing in a DPC practice, there is still a need for effective practice management. Staff members must have the skills to manage appointments as well as patient membership fees. Attitude. In a small office setting, such as that found in a DPC, the staff’s attitude toward the practice, toward the patient, and toward each other can make a significant difference in the patient’s experience. Staff must be able to communicate effectively with everyone involved with the practice, especially the patients. Dahl also writes that by 2020, about half of the workforce will be millennials, those employees currently in their mid to late 20s. When staffing the DPC practice, the independent physician must keep in mind that the “mindset of these employees is built around learning, involvement, and participation in the organization,” so putting a plan into place that enables this new workforce to grow and develop their own skills will prove beneficial as well.

Greg Miller
July 20, 2017

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Social Media for Direct Primary Care physicians

Direct Primary Care (DPC) physicians can use a number of marketing tools for promoting their practice and for educating patients. DPC is a relatively new concept and a DPC practice may need to clarify some information or provide additional details regarding the way the practice operates, to reassure potential and current patients. Social media can be an effective platform for reaching those patients. Millennials and Gen Zers, those patients in their mid to late 20s and younger, use social media as their primary means of gathering and sharing information. As millennials are approaching their 30s, they are getting married and starting families. A DPC practice that wants to attract this younger and largest generation of patients will need to have a solid social media presence. Care must be taken when implementing a social media strategy. Online posts can take on a life of their own, with shares and reposts. A DPC’s messages must be professional and appropriate. When initiating online communication where patient information may be at risk, physicians should carefully avoid any HIPAA violations. Sensitive situations include posting images of patients without their consent, compromising patient confidentiality by posting identifying information, and communicating with patients via a social media platform. DPC physicians should make use of their electronic health record EHR capabilities when communicating with patients, to ensure that any information transmitted is secure. Social media can reach a large number of people with just one post, but that one post requires careful planning and a bit of effort on the DPC’s part. A staff person may be assigned to post timely, relevant content and to respond to comments. For example, a DPC practice may decide to build a Facebook page that will require timely and consistent monitoring. These social media options do provide the DPC with an effective outlet for education and marketing, as long as they are planned and maintained in a manner that is engaging and professional.

Gabby Marquez
July 18, 2017

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5 reasons why patients love direct primary care

Direct Primary Care (DPC) is growing in popularity with primary care physicians. Under the DPC model, billing is virtually eliminated as patients pay a monthly membership fee rather than paying per visit. Physicians are also able to spend more time with fewer patients in a day as a DPC, given that their income is based on the monthly fee and not on the number of patients they see. Patients also have a number of reasons they cite as to why they love the DPC model. A recent blog post in Twine Health lists four of those reasons: -Less expensive. Patients pay a monthly fee instead of paying a copay or full fee at each visit. Insurance copays can add up when a patient has multiple primary care visits within a month’s time. With a DPC, there is only one payment per month and that is usually low, typically in the $25-$85 range. -More convenient. A patient can generally make an appointment sooner and receive more services than with the typical primary care physician model. Patients have more access to the physician during the visit as well as through communication in between visits. -More effective. In a DPC model, patients become more engaged in their own healthcare. The primary care physician is not just there to send patients to other providers, but is able to offer more “coordinated and continuous” care, an aspect particularly important to patients with chronic or complex illnesses. -More personal. Primary care physicians who operate under the DPC model see fewer patients per day and so are able to spend much more time with each patient. Their patient engagement increases, as does the patient’s satisfaction with the level of care received. A recent article in the Wall Street Journal adds a fifth reason why patients love direct primary care. In a DPC model, patients “can provide their own quality control.” If the model or the practice does not work for them, they can leave. The WSJ adds that, so far, “satisfaction rates run high.”

Greg Miller
July 17, 2017

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What the research says about Direct Primary Care

Direct Primary Care (DPC) is an innovative practice model that enables the independent physician to spend more time with patients and less time with billing paperwork. In a DPC practice, patients pay a regular monthly fee for services. The primary care physician does not bill the patient or an insurance company for each visit. While a relatively small percentage of physicians practice as DPCs, the model is growing in popularity and has support from organizations such as the American Academy of Family Physicians (AAFP). The AAFP cites research that shows that “DPC patients have better patient experience of care and improved clinical outcomes as they become more engaged in managing their own health care.” In the DPC model, patients have predictable costs as they pay a monthly membership fee that covers their primary care physician visits, lab tests, and communication with the physician beyond the office visits. The Wall Street Journal reports that physicians who operate as DPCs “say the steady income from membership fees frees them from having to pack patients into 10-minute visits to make ends meet.” They are able to focus more on patient engagement while the patient is in the office as well as “handle many issues via text or email, which are rarely reimbursed in traditional fee-for-service medicine.” According to the WSJ, research also shows that the DPC model “may work particularly well for patients with complex medical conditions who need careful monitoring and help coordinating multiple specialists.” A patient with a chronic or complex illness may need to visit the primary care physician multiple times each month, all of which would be covered under a single membership fee. As there is still a small percentage of physicians operating as DPCs, there is little research available as to whether the model actually helps improve patient outcomes. As DPC grows, however, it's likely that researchers will be more interested in studying how the model impacts access to care, care quality, and healthcare costs.

Gabby Marquez
July 13, 2017

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Concierge Medicine vs. Direct Primary Care

Healthcare delivery comes in many forms. The traditional independent primary care physician model, in which physicians see a number of patients each day and then bills insurance companies for their services, is somewhat transforming. Over the past couple of decades, two new models have risen in popularity: concierge medicine and direct primary care (DPC). While there are some similarities in the two, there are also a number of differences. Both the concierge and the DPC models have as their core a membership fee paid by the patient, or sometimes the patient’s employer. Concierge practices may also bill the patient’s insurance company for covered services, while the DPC practice usually relies solely on the membership fees to cover costs. Membership fees provide direct access to physicians in both models. When the physician is not relying solely on insurance reimbursements to finance the practice, the number of patients seen each day can be reduced, so the physician has more time to spend with each patient. In the concierge model, the membership fees may be slightly higher and the patients may receive increased access to their physician’s services. A study cited by the AAFP and conducted by the Concierge Medicine Research Collective found that “people age 50 and older make up an increasing share of patients at most concierge practices.” Typically, these concierge services are more concentrated in states such as California and Florida, which have higher populations of patients over age 50. Those concierge practices seeing Medicare patients or that are billing insurance companies in addition to the membership fee are subject to the relevant rules and regulations. DPC models that do not bill insurance are not subject to Medicare or insurance regulations. The DPC model is identified in the Affordable Care Act as an acceptable non-insurance option, but the concierge model is not. In both models, patients enjoy the individual attention and communication they receive from their physicians. Physicians are better able to focus on patient care with fewer worries about practice management issues. An independent physician considering a transition to either model will need to weigh all of the pros and cons for the practice and for the patient before moving forward.

Greg Miller
July 10, 2017

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Choosing an EHR for DPC practices

Choosing an electronic health record (EHR) system is an important step for Direct Primary Care (DPC) practices. Since a DPC practice usually operates on a “retainer” system, the practice must be managed in a cost-efficient manner while still providing quality patient care. The right EHR can certainly help in making that happen. What are some considerations a DPC should factor into the choice of an EHR? Although DPCs may differ somewhat in their structure, the defining characteristic of a DPC is that the practice offers patients “the full range of comprehensive primary services, including routine care, regular checkups, preventive care, and care coordination in exchange for a flat, recurring retainer fee,” according to an article posted by AAFP. DPC physicians typically see fewer patients during a day and are able to focus more on the quality of their patient’s care. Given this structure, an EHR system must enable the DPC physicians and their patients to communicate with each other using seamless, secure messaging. Elation’s EHR solution provides this capability and more, to support the physician-patient relationship. Patient engagement is a significant contributor to the quality of their healthcare management plan, a primary focus of the DPC practice. A DPC practice must also streamline its overhead, to remain solvent while focusing on patient care. Elation’s Clinical First EHR offers DPCs the tools they need to minimize practice overhead for more efficient practice management. With the right EHR solution, physicians in a DPC practice spend less time on paperwork and more time with the patients themselves. Time wasted searching for information or waiting for information from other providers is virtually eliminated. The AAFP states that given the DPC practice structure, the physicians in the practice “are no longer generating revenue solely on the basis of how many patients they see per day, [and] many report that they have significantly more time to spend with patients in face-to-face visits.” Patient focus is also Elation’s goal and we have designed our EHR solution to help DPC spend more time with their patients and less time with their patient records.

Gabby Marquez
June 21, 2017

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What is Direct Primary Care?

Direct Primary Care (DPC) is a model of primary care that gives physicians alternatives to traditional fee-for-service insurance billing. Direct primary care physicians charge their patients a retainer, whether it be monthly, quarterly, or annually that is used to cover services. Often supplemental insurance for emergencies situations is suggested. The DPC Model Spending more time with patients is the ultimate goal of DPC. The core principles are patient-centric and prioritize the patient-physician bond. The unique payment structure of direct care eliminates many of the administrative burdens physicians face, freeing up more time to focus on a patient’s care plan. Engaging with patients is another priority for DPC physicians. Patient engagement can include sending and receiving messages with patients, communicating lab results and discussing general health information. Keeping a channel of open communication with patients builds trust and subsequently strengthens the patient-physician relationship. Benefits of DPC for Physicians DPC rewards physicians for treating the whole patient. Because DPC physicians are not as concerned with the number of patients seen per day, physicians can spend more quality, face to face time with patients and can develop stronger relationships with their patient population. DPC physicians also reported reduced overhead costs at their practices compared to traditional primary care practices. Many of the administrative duties are reduced because there is no longer a need to hire staff that handles third-party insurance claims. Simplifying the billing and administrative work for physicians also provides DPC physicians with a better work-life balance. Physicians experiencing burnout might find the schedule of a DPC physician, with a more intimate patient panel, appealing. Benefits of DPC for patients Smaller patient panels for physicians leads to more individualized and personalized care for patients. DPC physicians are easier to access and care is timely and convenient for the patient. Many DPC physicians even offer extended hours and are always available via phone. Beyond the greater access to comprehensive care, patients find that DPC care is oftentimes more affordable and more flexible to their unique needs. Whether you are interested in starting a DPC practice,  just starting out a DPC practice or a DPC veteran, doing your research and staying up to date on the latest on this ever-evolving and innovate model of care can help you achieve your practice goals. Learn more about direct primary care and the greater direct care movement by subscribing to this blog or downloading our recently released DPC playbook! 

Greg Miller
June 15, 2017

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