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Explore direct primary care, concierge medicine, and other successful direct care models.
It has long been known that the number of direct primary care (DPC) practices is increasing throughout the US. A concept that began in its current form only around the turn of the 21st century, the DPC practice is growing in popularity among independent physicians who no longer want to deal with insurance companies and with patients who appreciate the more personalized service they receive from their physicians.
The exact number of DPCs has only recently been mapped, however, and those numbers are showing significant increases in numbers of practices, numbers of patients, and average numbers of patients per practice. The DPC Trends Report uses the data from the mapping project to cull specific numbers and trends among DPC practices.
Data from the mapper shows that the number of DPC practices has increased to 620 in 2017, from 125 in 2014 when the data was first tracked. The total number of DPC patients in 2017 was 173,042, an increase from 5,988 in 2014. Average number of patients per practice increased to 279.1 in 2017, from 47.9 in 2014. Data for each year shows a steady and significant increase:
|Number of DPC practices||Estimated number of DPC patients||Average number of patients per practice|
There are still no reported DPC practices in North Dakota or South Dakota, but the mapper has tracked practices in all other 48 states as well as Washington, DC.
The numbers as tracked over the past four years are probably conservative, as no precise census exists yet to determine the exact number of DPC practices across the country. However, the mapper definitely shows a fast-growing movement toward the DPC practice for both patients and independent physicians across the US.
Gabby Marquez May 22, 2018Read
A streamlined, efficient operation is essential for the success of a direct primary care (DPC) practice. DPCs operate on patient membership fees and cannot rely on the income generated through insurance reimbursement. Likewise, the DPC practice must have the proper technology that ensures optimal results for minimal effort. This technology should also, and more importantly, enable the DPC independent physician to focus on the patients’ health while managing the practice efficiently.
DPC physicians tend to be heavy users of technology in their practices, due to the demands of retaining memberships. Practices need access to a wide-range of technology and services, from patient marketing platforms to labs and imaging services. Electronic health record (EHR) technology is optimized for and best suited to meet the needs of direct care practices.
A recent article published by the Mayo Clinic’s Center for Innovation stated that:
The problem-oriented EHR is ideal for Direct Primary Care because most encounters are characterized by multiple problems, which is different from a specialist, who typically sees a patient for a single problem during any given visit. Additionally, DPC medicine has a more holistic approach to patient health that neatly aligns with the problem-oriented medical record, which provides a longitudinal view of the patient’s health care over time.
The DPC community of independent physicians can benefit greatly from the features of an EHR solution that enables them to run their practice more efficiently while spending more time with their patients. Communication tools, easy access to patient medical data, and collaboration with specialty providers are key to a successful DPC practice.
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.
Gabby Marquez May 14, 2018Read
The direct primary care (DPC) physician typically chooses the DPC model out of a desire to spend more time with patients and less time with third-party paperwork, especially that dealing with insurance companies. So, many DPC physicians may be hesitant to reach out to employers to explore the idea of partnering their practice. However, the DPC practice must also find ways to become financially stable and partnering with employers to provide healthcare to their employees can be an effective way to do just that.
The DPC practice that wants to partner with employers should emphasize the advantages for those employers and their employees. By most estimates, employers that contract with DPC practices to provide healthcare to their employees can save up to 40% on their healthcare costs. In fact, some employers are willing to pay the entire cost of the DPC membership for their employees because they are saving so much overall.
In addition, the employees benefit by being able to see an independent physician who is able to spend more time with each one, developing that critical patient-physician relationship that can lead to better health outcomes. Employees are healthier and employers benefit from reduced absenteeism as well as an increased opportunity to recruit with the enhanced benefit.
DPC physicians who cater their practices to employer groups benefit from the opportunity for a captured patient panel. The practice becomes easier to grow with virtually guaranteed patient membership. The independent physician who works with employers can maintain the sanctity of the DPC model, while enjoying a solid, predictable income.
Independent physicians who partner with employer groups also have the opportunity to become an advocate for healthcare within the employee population group. Offering more personalized care, tracking each patient’s medical progress and/or challenges, and spending more time with each patient on preventive care can benefit the physician, the employee, the employer, and the community as a whole.
Gabby Marquez May 8, 2018Read
Back in the day, primary medical care involved only the independent physician and the patient. In the early 20th century, however, the concept of health insurance was formed as part of Theodore Roosevelt’s presidential platform. Today, primary care physicians are tasked with securing prior approval, billing, and awaiting reimbursements from insurance companies as a part of their daily practice management.
Direct primary care (DPC) is a relatively new concept that actually takes independent physicians back to those days of dealing directly with patients for payment as well as treatment. Based on patient membership fees that cover most basic services, the DPC model bypasses insurance companies almost completely.
One DPC “trailblazer,” Dr. Paula J. Frantz had participated in the fee-for-service traditional primary care practice for several years before deciding she needed to be able to spend more time with her patients and less time dealing with insurance companies. She launched her DPC practice in 2016, “on a mission to change the way people view health care by taking a trip back in time to re-visit a concept grounded in our collective medical history.”
The growth of the innovative DPC model is changing the way independent physicians and their patients think about healthcare, by eliminating the middle man of the insurance companies and returning to the original concept of the doctor-patient relationship. Complicated payments and reimbursements do not exist in a DPC practice. Instead, the patient pays a regular monthly fee directly to the physician’s office.
In return, the physician is able to spend more time with the patient during each visit and is generally more available for communications before and after the visit. Dr. Frantz’s patient visits can last anywhere from 30 minutes to an hour. Most visits in a traditional practice are limited to a maximum of 15 minutes. In the DPC practice, there is less emphasis on the volume of patients and more emphasis on the quality of patient care, which benefits physician and patient.
Gabby Marquez May 1, 2018Read
Direct primary care (DPC) operates on a unique financial model. Rather than submitting claims and relying on insurance reimbursements, the DPC physician bills patients for a monthly membership fee. These transactions require a different type of practice management system than that used by the traditional primary care practice.
The DPC practice “offer 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 that is typically billed to patients on a monthly basis.” This arrangement enables the DPC physician to spend more time with each patient, particularly when the practice incorporates the technology of electronic health records (EHRs).
DPC practices that rely on patient membership fees must be able to manage the practice efficiently to remain financially solvent. DPC EHRs must offer the independent physician the tools necessary to bill patients for their monthly fee as well as to communicate with patients regarding questions and clarifications for follow-up treatments.
Minimizing practice overhead is critical for DPCs. Important features of EHRs for these practices include integrated practice management tools to efficiently manage office appointments, send patient reminders, and collaborate on care with electronic faxing and referrals.
A primary focus of the DPC practice is to become more engaged with patients, spending more time with them at each visit and developing a positive, long-term relationship with each. DPC physicians also encourage patients to become more engaged in their own healthcare. An appropriate EHR solution can also help with that goal.
DPC EHRs, such as Elation’s Clinical First EHR, provide the ability to send and receive messages with patients to engage them beyond the encounter. Communication histories are automatically linked to the patient’s chart and are easy to find. The physician can securely share vitals, lab results, and encounter summaries through the HIPAA-compliant patient portal.
An effective EHR solution provides easy access to patient data and to practice management tools that are essential for the DPC’s success. Elation Health is focused on helping DPC physicians reach their goals, for their practice and for their patients.
Krystle Thornton April 25, 2018Read
The direct primary care (DPC) model is a relatively new and often misunderstood concept of healthcare delivery. Patients, policymakers, and even some physicians still need to be educated as to how DPC practices function, particularly how they can be financially self-sustaining and still offer high quality, personalized care.
Policymakers are the focus of an upcoming event hosted by the Direct Primary Care Coalition (DPCC). The DPCC Washington Fly-in is scheduled for May 21-22 at the Hall of States, 400 North Capitol St NW, in Washington, DC. The agenda is yet to be announced for this year’s Fly-in. In past years, however, DPC leaders from around the country have come to Washington “to focus attention on important federal policy changes to help DPC practices grow and improve health care for more Americans.”
The coalition is urging lawmakers to pass legislation regarding DPCs and their relationship to insurance, especially health savings accounts (HSAs) and the Affordable Care Act (ACA). Whether DPCs are considered insurers and must adhere to insurance regulations is of particular concern to many primary care physicians.
The DPCC May 2018 Washington Fly In is now open for registration. DPC physicians concerned about current and future legislation that may impact their practices are encouraged to register and participate.
DPC practices are growing in popularity. In 2005, there were fewer than 150 physicians practicing in direct primary care, concierge, and other direct care models. This number grew five times 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 helping independent physicians succeed in their DPC practices. Our Direct Care Playbook is designed to provide physicians with specific guidance on setting up a practice, marketing to and educating patients, and optimizing a practice for success.
Gabby Marquez April 23, 2018Read
Many direct primary care (DPC) physicians say they opened a DPC practice because they want to spend more time with their patients and less time dealing with insurance reimbursements. However, those well-intentioned desires alone are not enough to be successful as a DPC physician. The editor-in-chief of The Direct Primary Care Journal, Michael Tetreault, has identified six traits that are necessary for DPC success:
Tenacity. Physicians who convert their practice, leave a practice, or start a new practice as a DPC physician will generally not be immediate successes. Patients will have to be educated as to the DPC model and, in particular, the benefits to them as DPC patients. Successful DPC physicians will be able to persist through the challenging times to become successful over time.
Passion. Primary care physicians generally make the move to the DPC model because they have a passion to focus on their patients. They typically find that they are “allowed the opportunity to problem-solve and make life a little easier, better and cheaper” for their patients as DPC physicians.
Managing fear, uncertainty and potential failure. The shift to a DPC practice involves risk for the physician. Patients may not understand the concept or fear how it may affect and may even leave the practice. Physicians will not have insurance reimbursements to finance their practice, but will have to manage the fear and uncertainty of running a practice on membership fees.
Vision and task-specific confidence. Having a vision for success is an important trait for a successful DPC physician. As Tetreault explains, “If you’ve planned appropriately, conducted enough analysis and have sufficient research that you can provide the level of service you envision for your medical practices future to ameliorate the risk, you’re ready to take the next step.”
Planning, flexibility. DPC physicians must have the ability to plan well, particularly in regard to their patient-facing time and their budgets, but also have the flexibility to make adjustments when necessary and appropriate.
Rule-breaking. The DPC model is innovative; its membership-based structure runs counter to the typical primary care practice structure. Successful DPC physicians are able to break the rules of the traditional medical practice and take the entrepreneurial step necessary to start and run a practice that benefits them and their patients.
Gabby Marquez April 17, 2018Read
Direct primary care (DPC) practices are built on the premise that patients will pay monthly membership fees to cover the basic services provided by the practice and the primary care physician will not accept insurance from those patients. However, DPC physicians often recommend that patients secure high deductible insurance coverage for catastrophic events or to cover additional services such as specialty provider visits.
In a recent article published in Physicians Practice, Rob Lamberts, MD, also an Elation doctor, explains that uninsured patients may require additional strategies on the part of the primary care physician, even when they are being treated by a DPC practice.
Dr. Lamberts states that the patient who is not covered by additional insurance is “at constant risk of developing conditions that could quickly bankrupt them.” He further explains that this situation makes the job of the primary care physician, “who has to manage the care in such a way to minimize the need for specialists and hospital care, critical to both the health and financial well-being of the patient.”
Financial stress can certainly have an impact on patients who need additional services, such as x-rays, prescriptions, or visits to specialty physicians to treat a chronic disease. Dr. Lamberts states that the primary care physician who pays attention “to this real and significant stress will not only help the patient but will also reassure them that the care they are getting is comprehensive.”
In his article, Dr. Lamberts offers several guidelines for the primary care physician working with an uninsured patient:
In the words of Dr. Lamberts, “People are more than just physical bodies, and should be considered on all levels, including economic.”
Gabby Marquez March 22, 2018Read
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, 2018Read
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, 2018Read