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Explore direct primary care, concierge medicine, and other successful direct care models.
The direct care model of medical practice is often misunderstood, to the point where those who are not clear on its structure or purpose may pose a series of objections to the independent physician in a direct care practice. Providers who choose to transition their practice from a traditional model to a direct care practice, in particular, may face questions about why those chose to do so.
Rob Lamberts, MD, a board-certified internist and pediatrician who runs Dr. Rob Lamberts, LLC, a direct primary care practice in Augusta, Georgia, and who is an Elation Health Clinical EHR user, offered his own experience with objections as well as ways in which to address them, in a recent article in Medical Economics.
Common objections to the direct care model include:
DPC is elitist. The direct care model of medical care is often associated with concierge medicine. Those who are unclear as to the concept may confuse the idea of a concierge physician, who charges somewhat higher monthly fees, with the idea of a direct care provider, who typically charges between $35 and $75 per month. In fact, direct care practices usually discount their monthly patient membership fees depending on age and, in Dr. Lamberts’ case, the patient’s ability to pay.
DPC is not scalable. The direct care physician tends to have a smaller patient panel. Dr. Lamberts went from approximately 3,000 patients to 750 in his practice when he transitioned to direct care. The quality of care that a direct care physician can provide patients is significantly higher, however, as the provider has the opportunity to spend more time with each patient. As Dr. Lamberts states, “what is more valuable to society: giving poor care to 3,000 people or excellent care to 750?” in addition, Dr. Lamberts points out, “DPC is far better for the doctors, and will likely slow the burnout rates afflicting primary care at this time.”
What happens when patients need specialty or hospital care? Direct care patient membership fees cover basic primary care services. Labs and discounted prescriptions may also be included, depending on the practice. Patients are encouraged to carry high deductible insurance for catastrophic events such as hospitalizations because the direct care physician offers patients high quality and affordable healthcare, which “can (and does) reduce the need for specialty care, ER visits, and hospitalizations, but it doesn’t eliminate it.”
Dr. Lamberts concludes that direct care “takes a number of steps towards some desperately needed changes (in the healthcare system): lower cost, less over-utilization, happier doctors and healthier patients.”
Krystle Thornton February 6, 2019Read
Direct primary care (DPC) physicians need an electronic health record (EHR) system that enables them to manage their practices, maintain accurate and easily accessible patient records, and spend more time with their patients. Online billing, payment, and appointment capabilities are also critical to a successful DPC practice. Integrating partners to provide these features in one EHR solution is the key to Elation’s ability to give DPC practices what they need.
At Elation Health, we work with industry partners to offer DPC physicians a complete solution for their practice management:
Hint – offering advanced enrollment, billing and growth analytics services. Integrating with Hint enables Elation to provide DPCs with a “highly customizable enrollment, billing and eligibility management engines (that will) let you design and automate complex consumer and employer plans in minutes.”
Spruce – boasting “Modern care that providers, patients, and employers love,” Spruce’s features enables Elation to integrate “communication and care for the 21st century” into our EHR solution.
Hale – a remote care platform that lets clinical teams streamline triage, automate follow-up, and increase practice capacity – all while delivering an incredible patient experience.
KPI Ninja – offering a “portfolio of cutting-edge analytics solutions” and focusing on issues of particular concern to DPC physicians, such as population health, Elation integrates with KPI Ninja on capabilities from “identifying social determinants of health to measuring health outcomes.”
Health Biller – integrating direct care practice management as well as patient data enables Elation to provider DPC physicians with a practical and comprehensive EHR solution.
Elation is about building a technology platform that doctors and patients use because they want to use it. Because they trust it. Because it improves the quality of care. Because it makes them more productive and more effective. And most of all, because it deeply respects that the heart of healthcare is the doctor-patient relationship. Integrating with industry partners enables us to provide the highest quality EHR solution for our DPC clients.
Krystle Thornton January 28, 2019Read
The direct care and concierge care models may not be the right fit for all patients. These practice models differ from each other as well as from traditional primary care practices. Typically, the direct care practice offers basic services for a monthly membership fee of between $50 and $100. Concierge care is a bit more expensive and offers more personalized services for its patients. Certain types of patients might benefit more from participating in each of these primary care practices than in the traditional model.
The direct care model is growing in the US, with almost 900 practices now providing quality healthcare to patients. Direct care physicians focus on their relationships with their patients, getting to know them and their needs and preferences through direct interactions during the visit as well as outside normal operating hours. Direct care physicians have been known to make house calls and make themselves available to communication from patients via electronic modes and direct calls.
Patients who desire this type of personal medical service will benefit from either direct care or concierge care. Those who tend to need more primary care services, perhaps because of a chronic or complex condition, will also benefit from participating in a direct care practice. Basic primary care services, including x-rays and some laboratory tests, are covered under the monthly membership fee. Many direct care practices also offer reduced costs for prescriptions and wellness services.
Most direct care physicians do not accept insurance but do encourage patients to carry high-deductible insurance for services not covered, such as hospital admissions. For patients who already have high-deductible insurance plans, enrolling in a direct care or concierge care practice will benefit them financially. Older patients, especially, may see significant cost savings. A survey 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.”
Consumer Reports states that, according to the Kaiser Family Foundation, “Three-quarters of those with employer insurance have co-pays (out-of-pocket fees per office visit) for primary care that average $25, and one-quarter have co-insurance (a fee based on a percentage of cost of a visit), which averages 19 percent. And 81 percent have deductibles that average $1,500 before insurance kicks in.”
Patients who visit the primary care physician often and who are concerned with the costs of their healthcare coverage will certainly benefit from the direct care and concierge care structure, both in terms of financial savings as well as healthcare outcomes.
Krystle Thornton January 22, 2019Read
Direct care physicians 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? Physicians should ask themselves:
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 and must keep workflows efficient and inform decisions at the point of care. Some key questions to consider when choosing an EHR:
Direct care practices are growing in popularity with independent physicians as well as their patients. In the direct care model, physicians see fewer patients in a day and offer those patients the opportunity to communicate with them outside the office visit, to ensure higher quality outcomes. As AAFP explains, “The opportunity to spend more time interacting with patients and providing ongoing follow-up services is at the heart of the patient-centered care provided in DPC practice settings.”
Communication is an important aspect of the direct care practice. Online tools that enable the direct care physician to communicate with patients who may have questions or concerns after hours or who need to clarify instructions for care or medications play a key role in the practice’s success. Online tools for communicating with potential patients, including a website and social media, are also critical, giving the direct care physician a virtual platform for educating those patients and marketing their practice.
Technology can help direct care physicians measure and analyze the goals and metrics they set for their practice. Once these goals are outlined, measured, and evaluated, direct care physicians should analyze their performance and ask important questions about their business performance. By clearly indicating the tactics and strategies employed, providers can then isolate what worked and what didn’t work.
Krystle Thornton January 9, 2019Read
For some direct care physicians, the idea of being available to patients around the clock may seem daunting. Who wants to be awakened every night in the middle of the night? However, most direct care physicians also find that they are able to develop a relationship with their patients that includes respect, boundaries, and established expectations.
The idea behind the direct care model is that patients pay a monthly fee and, in return, have access to basic primary care services during office hours as well as access to their physician after hours. That is an enticement for both doctor and patient, that the patient interaction is not limited to a 10-15 minute visit during the day. The physician can spend more time during each visit, getting to know that patient more completely, and the patient feels free to ask follow-up questions and clarify instructions before and after the visit.
Direct care physicians have found that their patients do tend to respect their time and do not take advantage of their 24/7 availability, but it helps to establish expectations up front. Some direct care physicians will state that they are available by text or email – but not phone calls – between certain hours. They may also specify when it is appropriate to contact them after hours. For example, a question about scheduling or administrative issues must wait until office hours.
When the direct care physician offers 24/7 availability and the patient does call in the middle of the night, however, the physician should be responsive to continue that positive relationship. If the call went to voice mail, the physician should return the call. Likewise, a text or email should be answered promptly. Of course, all physicians direct their patients to call 911 when they have such emergency situations as a potential heart attack.
Krystle Thornton December 14, 2018Read
One of the major attractions of a direct care practice for patients is the simplicity of the model. Patients pay a monthly membership fee for which they receive basic primary care services. The benefits include more time with their physician, including time outside the office visit, and no need to stress over insurance coverage for their primary care visits. Monthly membership fees can range from $50 to $150, depending on age and provider.
Some direct care providers also charge a registration fee, typically between $50 and $99, payable before the first patient visit. The registration fee is seen by some as a reasonable fee for setting up a billing account. Other direct care physicians see the registration fee as a sort of security against patients who may take advantage of the low monthly fee to access their healthcare services for the first month only and then drop out of the practice.
Many direct care practices do not require patients to commit to a long-term contract. In these cases, the patient could pay the first monthly fee, go to their appointment, receive their full direct care health services, and then not pay any additional fees. Some physicians see this possibility as the patient taking advantage of a “quick and cheap” visit.
On the other hand, some direct care physicians see the registration fee as unnecessary and possibly even a deterrent. The point of the direct care model is to provide quality healthcare at lower costs, so adding a registration fee may be seen as a negative, a potential barrier to new patients.
Alternative solutions include having the patient agree to a minimum participation term. In other words, the patient may contract for three or six – or even twelve – months of direct care membership fees before they are allowed to cancel.
Given the benefits of the direct care practice, including higher quality care, more focused provider attention, and fewer overall costs, direct care physicians believe that patients will stay with their practice without a formal long-term commitment and without a registration fee.
Gabby Marquez December 10, 2018Read
When launching a new practice, the independent physician has a lot of factors to consider. Location, staffing, equipment needs, and office technology are all considerations to take into account with a new practice. When launching a direct care practice, there may also be questions about whether specific licenses are required. The answers to those questions for the direct primary care physician actually vary by state.
Most of the license or permit requirements depend on whether the direct primary care physician will dispense medication in-house. This is a service commonly provided by the direct care practice, in an effort to further help patients save money. According to a recent article published by AAFP, “Twenty-seven states allow physicians to dispense medication without a fee or license. Among states that require a license, the fee ranges between $10 and $300. Montana, Texas, New York and Utah do not allow physicians to dispense medication.”
The direct primary care physician who conducts any types of tests on patients must adhere to Clinical Laboratory Improvement Act (CLIA) requirements, including applying for a waiver for conducting basic tests. As outlined by the DPC Frontier, direct care physicians will “need to pay a fee (file for a waiver), … are subject to audits (to make sure you only do waived tests), and … must maintain extensive documentation (regularly updated) to prove compliance.”
There are also, of course, licenses and regulatory requirements typically applicable to the independent physician regardless of the practice model, including the basic medical license and malpractice insurance. The good news is, because DPC doctors have fewer claims than regular physicians, they can receive a nearly 50% discount on the cost of their malpractice insurance. With significantly lower malpractice premiums, DPC physicians can more easily obtain such insurance to protect their practices against potentially damaging lawsuits.
There are currently a number of policies at the state and federal level that that could impact direct care physicians. When launching a new practice, the direct primary care physician should review the legal considerations and understand all of the requirements, including those that may vary depending on the location of the practice.
Krystle Thornton December 3, 2018Read
Physicians attending the Direct Primary Care Summit in July 2018 were enthusiastic about the direct care model of healthcare. As the president of the Association of American Physicians and Surgeons (AAPS), Albert Fisher, MD, noted, “Palpable energy filled the lecture hall.”
Summit attendees learned about starting, promoting, and running a successful direct care practice from experts in the field. Most indicated that the model of working directly with patients, bypassing insurance and reimbursement-based regulations and paperwork, was attractive to them and their patients. As Dr. Fisher noted, “There is renewed interest in independence and autonomy. At the end of the meeting, I felt optimistic about the future of the practice of private medicine.”
Physicians were advised to plan carefully before launching a direct care practice. They were also shown how a direct care practice can benefit physicians and patients, particularly those patients who are “working people.” Many direct care physicians at the Summit were excited about working with employers to provide healthcare as part of their company benefit, noting that “DPC can offer convenience and is a good employee benefit. It may help reduce absenteeism for small employers. For the DPC practice, working with employers brings in new patients.”
Direct care patients enjoy the benefits they receive from personalized healthcare and from the cost savings involved in their membership. Many direct care physicians who spoke at the Summit dispensed medications in-house, in particular cost-saving generics, and believed that “In-house drug dispensing is a great financial benefit to patients.”
Marketing advice for the direct care physician included using review pages such as Yelp to reach new patients. These review pages include testimonials from satisfied current patients, which do more to promote the direct care practice than paid advertising. As Dr. Fisher noted, “Patients have a much more positive experience in DPC” and will be likely to provide good reviews for their direct care physician.
Krystle Thornton November 29, 2018Read
In an effort to combat rising healthcare costs and to address health issues faced by their employees, a growing number of employers are contracting directly with physicians to provide care for their companies. Direct care practices typically provide healthcare to individual patients, contracting with them for a monthly membership fee. The expansion of direct care as an employer healthcare plan is also gaining steam with many organizations.
The direct to employer care model has been shown to benefit the provider as well as the employer. Providers build their practice by contracting directly with employers and those employers are able to offer their employees healthcare coverage that is effective and typically less expensive.
A recent article in Healthcare Dive outlines three common types of direct relationships between employers and providers:
The 2017 22nd Annual Willis Towers Watson Best Practices in Health Care Employer Survey found that 22% of employers anticipated directly contracting with providers to secure improved pricing of medical services by 2019. That number is a significant increase from the current 6% of employers who contract directly with healthcare providers for their employees’ care.
Large organizations such as WalMart are among those who have chosen to move toward the direct to employer care model. WalMart is the biggest private US employer. The company offers a COE network focused on reducing unnecessary spinal surgeries for its employees through a value-based payment program, incentivizing specialist to provide quality treatment through bundled payments.
The Willis Towers Watson survey found that employers recognize the employee experience with health and well-being is becoming increasingly important. Providing innovative, quality healthcare options to employees is a key strategy for employee recruitment and retention as well as for reducing costs for the employer.
Gabby Marquez November 14, 2018Read
Earlier this month, Elation joined hundreds of physicians and physician leaders dedicated to the direct care movement at the Direct Primary Care Conference, previously known as DPC Nuts & Bolts.
During the event, several direct care physicians shared their journey toward direct care and how they have managed to grow their businesses while focusing on providing intimate, comprehensive, high-quality patient care. Many of these physicians included Elation users who rely on Elation’s Direct Care EHR to seamlessly provide care.
Elation’s team also had the chance to demo our platform for attendees thinking about starting an direct care practice or finding out more about a tailor-made EHR system. Among the features that were highlighted included:
-Access to the largest network of DPC providers to enable you to provide more collaborative care
-Integrated practice management tools that will allow you to run your practice more efficiently
-Patient engagement features to help you provide more innovative care
-The partners and integrations we support to give you a more robust DPC solution
-Elation’s dedicated 24/7 support and hassle-free onboarding process
-Our robust access to resources to help your practice flourish
We’re excited about the direction direct care is headed in and we want to continue the momentum that was ignited at the Direct Primary Care Conference so that more and more patients have access to phenomenal care.
Interested in learning more about Elation for Direct Care? Click here.
Krystle Thornton November 12, 2018Read