DPC state laws: everything you need to know pt. 2

States across the country are introducing, passing, or vetoing bills that would directly affect direct primary care (DPC) practices, in regard to whether they are considered insurers. Some argue that because they require an upfront payment to cover an undetermined amount of services each month, they should fall under insurance regulations. Others contend that the DPC model is a physician-patient contract, without the “middle man” of insurance concerns.

Twenty-three states have passed laws regarding DPCs, their definitions, and their relationship to insurance, including whether they fall under insurance regulations. Eight states passed legislation in 2017. Those states with current legislation include: Washington, Utah, Oregon, West Virginia, Arizona, Louisiana, Michigan, Mississippi, Idaho, Oklahoma, Missouri, Kansas, Texas, Nebraska, Tennessee, Wyoming, Arkansas, Kentucky, Colorado, Indiana, Virginia, Alabama, and Maine.

The state of Oregon has DPC-related legislation in place that, in some opinions, needs to be revised and updated. The law does not explicitly state that DPC is not insurance. In addition, it grants the Oregon Department of Insurance the ability to investigate and subpoena DPC practices as well as broad authority to adopt new rules regarding DPC practices.

The state of Arizona has determined that “Direct primary care provider plans that are issued pursuant to title 44, chapter 11, article 25 are not insurance.” However, there are concerns that the legislation does not provide protection against insurance regulations since the definitions also include the phrase “if the plan does not assume financial risk or agree to indemnify for services provided by a third party.”

Bills regarding DPC regulations have been introduced in Florida and Georgia but have not yet passed due to timing issues or simply not being included in a vote. West Virginia and Arizona updated and revised their legislation in 2017, both of which are thought to be improvements on previously restrictive regulations. Pennsylvania has just recently introduced legislation related to DPCs.

Gabby Marquez
March 20, 2018


DPC state laws: everything you need to know pt. 1

Direct primary care (DPC) is a medical practice model where providers contract directly with patients. DPC practices typically do not accept insurance but DPC physicians do encourage their patients to acquire a high-deductible wraparound policy to cover the services not provided under their DPC membership fee.

Currently, the Affordable Care Act “allows direct primary care providers to participate in the insurance exchanges with the requirement that providers must be coupled with an insurance policy covering non-primary care services,” although DPC practices have not yet taken off as part of the exchange. Given the continuing debate over ACA policies and the repeal of the individual mandate, the conversation about whether DPCs are eligible for the exchange may not be as big an issue going forward.

However, the debate over whether DPCs are considered insurance for regulation purposes continues. Many states have passed laws specific to regulatory concerns, in particular defining whether a DPC should be considered “as a medical service outside of state insurance regulation.”

The state of Washington passed legislation, “Direct Patient-Provider Primary Health Care,” stating that a DPC is not an insurer. In addition, the legislation reads:

Washington needs a multipronged approach to provide adequate health care to many citizens who lack adequate access to it. Direct patient-provider practices, in which patients enter into a direct relationship with medical practitioners and pay a fixed amount directly to the health care provider for primary care services, represent an innovative, affordable option which could improve access to medical care, reduce the number of people who now lack such access, and cut down on emergency room use for primary care purposes, thereby freeing up emergency room facilities to treat true emergencies.

On the opposite end of the debate, the state of Montana has attempted several times to pass legislation that would benefit DPC practices, but the bills have been vetoed at the governor level.

Follow our blog to continue reading the latest on DPC state laws.

Gabby Marquez
March 16, 2018


Addressing common direct primary care (DPC) myths

Direct primary care (DPC) practices are growing in the US. The DPC model is based on patient membership fees for basic, primary care services, instead of insurance payments. For those who are concerned with the rising costs of healthcare, including the cost of insurance, the DPC option can be an affordable, workable alternative.

Many DPC physicians do encourage their patients to secure high-deductible insurance plans that cover catastrophic services, but for most patients a typical membership fee of $60-75 a month can cover all of their basic services. Even with the enticements of lower monthly payments and increased time and access to their DPC physician, however, many patients are still concerned with a number of myths surrounding the DPC practice.

John Bender, M.D., M.B.A., recently described a few of those myths in an article published by the American Academy of Family Physicians (AAFP):

Myth: With panel sizes of 900 patients, there is no way we can possibly come up with enough family physicians to provide primary care for everyone.

Dr. Bender contends that the DPC model will actually encourage more new graduates to enter the primary care field and will draw current, burned out physicians back to “do what they became physicians for in the first place.”

Myth: DPC is capitated insurance.

DPC physicians set their membership fee based on what they need to sustain their practice while providing basic, quality primary care services for their patients. They do not provide – nor do they generally accept – insurance and they do not take on underwriting or actuarial risk.

Myth: DPC will exacerbate disparities in health care.

The concern in this myth is that DPC practices will only serve a specific population. In many states, regulatory restrictions are prohibiting certain groups from taking advantage of the DPC model. In fact, most DPC practices are willing and eager to provide services for underserved groups such as Medicaid recipients, as well as for employer groups.

Gabby Marquez
March 14, 2018


Do direct primary care patients need insurance?

The direct primary care (DPC) model operates primarily on patient membership fees. Independent physicians in a DPC practice set their monthly fees based on several factors, including their income needs and, often, their patients’ ages and basic primary care needs. For example, a DPC practice might charge a different monthly fee for babies as it would for older adults.

Even though the independent physician in a DPC practice generally does not accept insurance for the basic services provided on a normal basis, DPC patients are sometimes encouraged to secure high deductible, catastrophic insurance for those services not covered under the monthly membership fee.

DPCs can be a positive solution for the uninsured to receive basic medical services; however, those catastrophic illnesses require additional treatment and the costs can be devastating for patients who do not have the appropriate insurance coverage.

The basic membership fee charged by a DPC practice 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 that high-deductible wraparound policy to cover the emergency care that is not covered under direct care.

A recent article in Business Insider describes the potential need for such insurance for DPC patients, using the example of car insurance: “You don’t use your car insurance for small transactions like oil changes, but it’s there for you if you get in a car accident. Likewise, health-insurance plans — especially those with high deductibles — can be there if you require healthcare beyond primary care.”

In addition, many DPC practices use hybrid models to combine elements of direct care and fee-for-service, and bill insurance in addition to contracting directly with patients. Hybrid practices are popular for physicians who want to continue to see insurance patients while also transforming their practice towards direct care. Providers interested in a hybrid model should consult legal counsel to make sure they are compliant with insurance regulations.

Gabby Marquez
March 12, 2018


How to manage direct primary care (DPC) practice reviews

Word of mouth has gone virtual. Online reviews are playing a more significant role in a patient’s decision to choose an independent physician. In the case of direct primary care (DPC) practices, patients who want to learn more not only about the physician but about the practice model itself will go online to see what others are saying.

When patients leave positive reviews, that certainly helps a DPC practice. The reality is, however, that most people only leave reviews for a business when they are dissatisfied with their experience. It’s just human nature. How can a DPC practice encourage positive reviews and how should it manage all patient reviews, to get the most out of them?

The first step in generating positive reviews for the DPC practice is to give the patient the highest quality care and to show appreciation to that patient. It is also human nature to remember the last thing said or the last interaction. Ensuring that patients are satisfied as they walk out the door will help increase the number of positive reviews for the DPC practice.

Primary care physician Napoleon Maminta, MD, says that “Garnering a high rating is automatic so long as you spend the time to get to know your patient, listen to their issues, provide multiple options for treatment, stay knowledgeable and up to date in your area of expertise, and communicate.”

The next step is to ask for a review. Garrett Smith, CEO of InboundMD says, “When asked, most patients will leave an online review. This means you must consistently ask patients for reviews in order to get more reviews online over time.” Incorporate the request into the check-out process or automate it as part of email follow-up. Respond with appreciation to those positive reviews!

Negative reviews should be seen as opportunities to improve the DPC practice. Whether to respond to a negative review may depend on how it is presented and if it truly appears to be valid. Sometimes it actually backfires to stoke a negative fire. However, a positive word about the practice’s efforts to provide quality care for all of its patients can go a long way toward managing negative reviews!

Gabby Marquez
February 13, 2018


Should your direct primary care (DPC) practice create a Yelp page?

Online reviews are the first thing many consumers check when deciding to do business with a company – and when deciding on a new physician. For direct primary care (DPC) practices, positive online reviews can actually help educate potential patients on the practice structure and encourage new patients to call for an appointment. In fact, the online review site Yelp says that “84% of consumers turn to review sites to find a doctor.”

Should your DPC practice establish an online presence on review sites such as Yelp? With that many potential patients turning to these sites for research when looking for a new doctor, it is undoubtedly a good place to be when you get positive reviews. Online review sites appropriate for DPC practices include Yelp as well as Healthgrades, RateMDs, and WebMD.

Care should be taken when you list your DPC practice on these sites, however, to ensure that your practice information is accurate and current. Most review sites encourage doctors to post a profile photo and to give potential patients sufficient details about the practice so they can make an educated decision.

Patient reviews are the new, virtual word-of-mouth advertising that may result from having a presence on these sites. Encourage your current patients to post reviews and respond quickly and appropriately to messages on the sites. Consider your responses carefully and be sure they are generic enough to avoid conflicting with HIPAA privacy regulations.

When a patient posts a review mentioning a specific visit or asking a question about a particular health concern, for example, your response should always be general in nature. You should thank the reviewer for commenting and then respond in a manner that does not confirm the reviewer as a patient or provide any suggestions for treatment or diagnoses. Just because the reviewer may have posted personal information it does not give you, as the healthcare provider, the right to violate his or her privacy!

Gabby Marquez
February 8, 2018


Physician gives insights on transitioning to DPC

Most doctors decide to become doctors because they want to help people. They want to work with their patients on plans to keep them healthy and to practice medicine in a way that truly makes a difference in their patients’ health outcomes. Many physicians, like Julie Gunther, M.D., of Boise, Idaho, discover that the reality of a medical practice comes with administrative tasks that may keep them from interacting with their patients as much as they’d prefer.

Wanting to be known as “Dr. Julie” in the “Marcus Welby” model of medicine, Dr. Gunther decided to launch a direct care practice (DPC) to serve her patients better, “because it’s what our patients want.” The DPC model operates on patient membership fees and typically does not accept insurance. Patient panels are lower in a DPC practice and administrative costs are significantly reduced.

Independent physicians who practice in the DPC model find that they have more time to spend with each patient, to build relationships, and to truly get to know each person and their specific healthcare needs. However, Dr. Gunther says that independent physicians considering launching a DPC practice should “know that DPC can be exhilarating, but it won’t be easier. You’re not going to work less, but you’ll feel a whole lot better.”

Homework is essential to the process. Dr. Gunther wrote an extensive business plan and shadowed other DPC physicians before finally making her move. She advises that a lot of work will have to be done on the marketing side for a DPC practice. Everything from a name to a logo to social media presence is something to consider at the beginning.

Elation Health has published the Direct Care Playbook to guide independent physicians through all the steps necessary to establish and promote a DPC practice.

Dr. Gunther’s final piece of advice to those considering the move: “Be a great doctor, and create a system that allows you to be a great doctor.”


Gabby Marquez
January 30, 2018


How to make your DPC practice more efficient

A Direct Primary Care (DPC) practice operates on patient membership fees primarily. Most DPCs do not accept insurance. Given their unique structure, it is important for a successful DPC practice to be optimized so that it operates as efficiently as possible.

The patient panel is key to a DPC’s operations. In the DPC model, patients pay a monthly membership fee and receive basic services without additional cost. To manage a DPC practice efficiently, the independent physician must balance those fees, which are essentially the only income for the practice, with the costs of providing care and managing the practice.

As your DPC develops a larger patient panel, you will have more income of course. However, with the enlarged panel comes additional expenses related to practice management. Making the DPC practice more efficient means you will be able to more fully focus on your patients and enjoy a successful practice, financially.

Dr. Rob Lamberts, writing in KevinMD, states that the “DPC relies on the simplicity of the care model to give enough efficiency to keep overhead low, cost to patients down, and to allow for larger patient panels.” The DPC model is relatively simple, allowing the independent physician to run a practice with minimal staff and overhead costs.

Technology can be a significant factor in the efficiency of the DPC practice. Using tools such as electronic health records (EHRs), physicians can streamline and optimize current workflows to allow for greater efficiency and consequently, a larger panel of patients. EHRs enable independent physicians to manage their patients’ medical data efficiently, accessing the information they need quickly and easily.

Managing a DPC practice efficiently involves:

  • Delivering a great patient experience so the practice retains those patients and the patients spread their positive experience with other potential patients
  • Finding a care-focused EHR solution to manage patient data, collaborate with specialty providers, and communicate with patients
  • Thinking strategically about growth so that the patient panel does not increase too quickly for the business to continue to be financially healthy.

Gabby Marquez
January 22, 2018


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


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