Direct Primary Care Pros & Cons

You’ve heard of health insurance and Obamacare, but what about “pay-as-you-go” direct Primary Care?

The UMHS Endeavour looks at this growing health care trend and why it is of interest to the public and future doctors at American and Caribbean medical schools. Will direct primary care help or hurt American medicine and consumers? We will examine the pros and cons, based on information from a Kaiser Health News article, the Direct Primary Care Coalition website and PhysiciansPractice.com.

Direct Primary Care

You may have heard of “concierge health care,” a system in which patients pay a medical practice big bucks on a monthly or yearly basis in exchange for access to doctors, doctor visits, blood and lab work and more. “Concierge” doctors don’t take traditional health insurance, and can focus on patients instead of insurance companies. The downside is “concierge” health care is expensive. Direct primary care follows the same concept “concierge,” but is affordable. How much? About $100 monthly for patients, according to a feature by Shefali Luthra on Kaiser Health News last week.

“The idea is that doctors can focus on treating patients, since they no longer have to wade through heaps of insurance paperwork,” Kaiser Health News wrote. "They spend less on overhead, driving costs down. And physicians say they can give care that's more personal and convenient than in traditional practices.”

Kaiser Health News said direct primary care is also becoming available to Americans on Medicare and Medicaid as well as to some state employees.

The Direct Primary Care Coalition (DPCC) website contains a lot of information about the concept but one thing is clear: This is not actually health insurance. In fact, the DPCC notes people should also have a high-deductible (catastrophic) health insurance plan for hospitalization, specialists, emergencies and other large expenses.

Direct Primary Care Coalition lobbyist Jay Keese told Kaiser Health News that more than 400 direct primary care practices exist in the USA, and more are slated to open in 2016.

Kaiser said the number of participating doctors could reach beyond 1,300. The American Academy of Family Physicians said an estimated two percent of 68,000 members offer direct care.

"This is a movement — I would say it's in its early phase," AAFP President Wanda Filer, a doctor in Pennsylvania, told Kaiser. "But when I go out to chapter meetings, I hear a lot more interest."

Patients of direct primary care practices enjoy the benefits of unlimited appointments and 24-hour e-mail access to staff. Some state governments are signing up employees for direct primary care.

New Jersey “is launching access this year for state employees including firefighters and teachers,” the Kaiser Health News article said. “When participants pick a primary doctor, they can choose a direct primary care-style practice that gives around-the-clock access to preventive and primary care services. The monthly fee has not been determined.”

Although direct primary care is growing in many states, there are critics.

The Cons of Direct Primary Care

Kaiser Health News noted the following about direct primary care:

• The fees involved may still be too high for some patients. A doctor in a Mississippi direct primary care practice said initial visits are $225, $125 for a follow-up and “about $50 per month after.” That might be too much for some.

• Kaiser said, “The number of participating physicians is low. There's already a nationwide shortage of primary care doctors. In this model, physicians see fewer patients, potentially exacerbating that shortage's impact. Also, Medicaid negotiates the monthly payment rate, which could be less than what doctors might set independently."

The website PhysiciansPractice.com says one downside "is that there is only one source of revenue: from the patient.  Consequently, the practice must be diligent with its financial planning to ensure the patient fees are enough to support the practice operations."

The site recommends hiring a consultant before converting a practice to direct Primary Care.

(Top photo) DIRECT PRIMARY CARE: The ‘concierge’ concept is gaining momentum in 2016, but direct primary care costs less. The state of New Jersey will soon offer direct primary care coverage to employees. However, this is not traditional insurance & insurance is still needed for specialists & hospital coverage. Photo: Andrawaag/Wikimedia Commons

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