DPC Coalition Fly-In is a resource for those interested in direct primary care policy

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, 2018

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Traits of successful direct primary care physicians

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, 2018

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Providing direct primary care to uninsured patients

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:

  • Cost Will Drive Care. Decisions on whether to send a patient to a specialty physician should take into consideration whether that patient can afford the specialty visit and whether it is truly necessary. Many times, the primary care physician can offer alternative solutions that will benefit the patient’s health without being an additional cause of financial stress.
  • Know Where to Get the Lowest Prices. Medications can become one of the most expensive aspects of a patient’s treatment plan. The cost of prescriptions can be reduced through research into programs that offer discounts and even pharmacies that may have a program for low-income or uninsured patients.
  • Be Firm When You Have To. Care for an emergency or urgent situation, like appendicitis, cannot depend on a patient’s ability to afford treatment. Many healthcare facilities also offer programs for low-income or uninsured patients.

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, 2018

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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

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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

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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

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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

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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

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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

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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

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