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Direct Primary Care - How New Health Model Is Changing The Game

Meredith Miller Published: January 15, 2019 Updated: January 15, 2019

Direct primary doctor

Healthcare has been at the political forefront for years due to its rising costs, and it’s getting more difficult to argue that insurance companies and regulatory policies aren’t two driving factors. Fortunately, a growing amount of physicians and medical groups are doing what they can to take back their medical practices, and even more so, their relationships with their patients. Direct Primary Care (DPC) is a newer trend emerging in the field of patient care. The trending healthcare model is not for everyone, but it’s worth the time to read up on and examine the pros and cons to make your decision.

What is Direct Primary Care?

Direct Primary Care is a way for physicians and patients to have less insurance company involvement and billing, and more opportunity for communication regarding care. This model gives greater control to both the primary care provider and the patient. A defining component of this the DPC model is the introduction of cash only doctors.

Cash only doctors charge far less for their treatments, and in many places, the medical group will let you know in advance what treatment will cost. Many doctors’ offices who work with traditional insurance are prohibited from doing this, which is a major reason more healthcare professionals and patients are turning to the direct approach.

How the DPC Model Works

In the Direct Primary Care model, your physician or medical group will charge a monthly fee. The patient then has access to their primary care provider within 24 hours of scheduling an appointment through their office, or the doctor may even conduct a house call. Furthermore, you, as a patient, would pay lower fees for an office visit. It also complements an HSA whose funds can be applied to a DPC billing.

Yes, in fact, there is a provision in the Affordable Care Act which allows a patient to utilize Direct Primary Care as an alternative to the traditional insurance. Direct Primary Care is also designed to work with low-cost, high deductible insurance plans, like catastrophic coverage.

How Much You Should Expect to Pay

Depending on the Primary Care Physician or medical group, you can expect to pay a monthly fee of around $50 to $500, depending on the provider of course. Your primary care provider will also charge a per-visit fee somewhere in the neighborhood $75. This fee structure can work with a patient’s general treatment plan, although if the patient has a more serious condition(s), or some sort of repetitive treatment, the monthly fee on top of that may not be ideal.

Can You Use Your HSA to Cover Costs?

Yes, this plan does provide a patient the ability to use their pre-tax HSA funds to help pay for their physician monthly fees, office visits, and other additional treatment charges. This would serve to make the plan more attractive as the patient has a payment option already available.

Direct Primary Care Pros

DPC grants greater control of treatment charges and quick access to the physician. The patient has a greater chance of feeling better sooner and longer as a result of timely and continuous care and gives them more confidence in their ability to speak with their doctor on their schedule. It also gives the doctors the ability to treat patients on their terms and with greater success.

Cons of Direct Primary Care

Doctors who take part in this care system only treat minor conditions, so if there is something more serious you need to be taken care of, it will cost you. Also, their fees and charges aren’t usually included as deductibles on a patient’s insurance plan. So, for many who are paying for even low-cost insurance, the monthly fee would seem too much money to many consumers.

The idea of doctors and patients being able to communicate and work with each other without the tangle of complications, rules and extraneous fees of the insurance companies was the idea of a tired, frustrated doctor named Steven Manning. Many doctors and patients around the country are much relieved that this is becoming a trend, introducing change into a weary medical care environment.