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.