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The 4 Characteristics of Direct Primary Care (DPC) w/ BONUS: ‘Let’s Put the Numbers Into a Nat’l Perspective.’

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“It is important to note that industry physician surveys, investment analysts and industry experts tell The DPC Journal’s research arm, The Concierge Medicine Research Collective, that they believe there are an additional 6,000 physicians who practice some form of Membership Medical Care (MMC) — i.e. albeit Concierge Medical Care or DPC, across the U.S. at this time (December 2014) equating to a total of approximately 12,000 MMCs operating in the U.S. — representing a total of just less than 6% of all licensed primary care physicians in the U.S. Another way to to look these numbers in perspective … is these 12,000 MMCs represent just over 1% of all licensed physicians in the U.S. across multiple specialties. According to the most accurate observers and news reports in recent past, we caution that exact numbers (<300 DPC; 5-6k up to 12k Concierge Care) are hard to track. The shift by physicians, despite hype, has been gradual. However, the positive data coming out of the MMC marketplace, usage and acceptance by consumers is growing at a moderate rate.” ~DPC Journal 2015 Annual Report and Market Trends Summary

By Michael Tetreault, Editor, The DPC Journal, Concierge Medicine Today, The Journal of Retail Medicine, DocPreneur Press (C) 2015

JUNE 1, 2015 (Updated/Revised: June 11, 2015) – “A lot of people (including the media, especially smaller, local news sources, and many doctors across the country) like to compare Direct Primary Care (DPC) to its demographically different — familial companion, Concierge Medicine.

They say … ‘Well … DPC is the less expensive alternative.’

To say this, puts DPC in an unnecessary box with a stereotype a growing sector in healthcare does not need in its infancy.

“We won’t move the cost-access curve and improve quality by balkanizing ourselves into factions based on subtle differences in practice models, services or billing frequency,” notes Dr. Robert Nelson, a direct primary care physician based in the Atlanta metropolitan area. “I can say with certainty that if we don’t unify for free-market, insurance-free practices of all stripes then the status quo claims culture will continue to march on to dominance while we fight on definitions.”

But many of the patient reviews, the patient interviews and even the physician industry service offerings say something completely different over the past two years since the interest in DPC has given physicians a career alternative and lawmakers pause in their legislative efforts.

collective1According to The DPC Journal’s patient insight polls comparing the monthly cost of DPC services to Concierge Care services … the difference is as little as $25?

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“Determining the right price point for the monthly DPC membership, and what services would be included in said membership were both of vital importance,” says Dr. Clint Flanagan and Dr. David Tusek of Nextera Healthcare based in Firestone, CO. “At first we considered charging a monthly fee accompanied by a very low fee per office visit. However, we both agreed the dual fee structure would create complexities and we were trying to simplify the delivery of primary care. Thus, we set a $99 per month individual price, $139 per month for couples, $179 per month for a four-person family, and $39 per month per child for additional dependents.”

Furthermore, there are some DPC offices that charge $200 per month and accept no insurance and the patients rave about their doctor. On the other hand, there are Concierge Care practices across the country that cost less than $125 per month and do participate in some local insurance plans.

MDVIP, the largest network of annual fee physicians to-date with over 600 locations across the U.S., highlights the positive expressions of transparent fees at affordable prices inside their hundreds of doctors offices.

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Cypress Concierge Medicine physician, Dr. Brian Nadolne, MD of Marietta, GA noted in his biography to patients … “I became a concierge physician for the same reason I became a doctor – I want to help people. With this model, I can continue to help people even when traditional medicine changes significantly. When a patient has a “one more thing, Doctor…,” the last thing I want to do is to cut the patient off. Patients deserve to be involved in their care and receive the valuable service of planning for optimal health with the guidance of a family physician who is dedicated to the care of the patient.”

All this to say, the “docpreneurial” spirit is alive, thriving and operating various price points. So, lets unpack this insight a little further and look ‘big picture’ at the DPC patient subtleties and offerings.

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Starting in 2013-2015, The DPC Journal and our independent research and data collection arm, The Concierge Medicine Research Collective (www.AsktheCollective.org), found that there are four (4) distinguishing factors that differentiate Concierge Care from its demographically diverse and often misunderstood companion, DPC … and it is NOT price …

  1. Insurance participation of the doctor/practice;
  2. DPC, most commonly, attracts a Gen. X and Millennial demographic under the age of 45.
  3. Monthly billing (seen at most DPC clinics), compared to annual and quarterly retainers offered at most concierge clinics, and;
  4. The amount of services offered.
  5. BONUS: It’s very popular among employers seeking to reduce employee healthcare costs.

New Book Release and “Recommended Reading List” (May 2015)Click Here …

In both Concierge Care and DPC, people have inherent, not ascribed value. There’s no class order … no first class or second class, just people for whom doctors serve each day. They’ve built clinics for children, families and people who are sick … and it is these visioneering physicians who are drawing attention to the cost of healthcare across the country and designing ways for it to be available and affordable for anyone.

“One of the main reasons I decided to make this huge career change into a Direct Primary Care practice was to give patients what they deserve from their doctor….time,” writes Dr. Jeffrey Gold, MD of Gold Direct Care based in the Boston, MA. area in an op/ed he wrote recently entitled “What We Strive For With DPC.”

Whichever business practice and business payment model you choose is your choice … and having talked to hundreds of patients and physicians in these two classifications of free market healthcare delivery over the past decade … I can tell you without reservation that it’s OKAY to be one or the other … but you don’t need to refer to yourself as BOTH any more.

  • If you are a Concierge Medicine doctor, be proud of it … because your fellow colleagues across the country en masse (approx. 6,000, source; Concierge Medicine Today, Summer 2015) certainly are.*
  • If you are a Direct Primary Care (direct care) doctor … own it, be proud of it, brand it your own … because your fellow colleagues (nearly 300, Source; The DPC Journal 2015 Annual Report, June 2015) certainly are also.*

*(Note: Since federal registration is not required nor is DPC or Concierge Medicine considered a categorical specialty on their own, these figures are an approximate count of the “true” and more accurately described “full-service” Membership Medicine clinics/practitioners (MMCs) operating across the U.S. from 2007-2015. It is also important to note that industry physician surveys, investment analysts and industry experts tell The DPC Journal, that they believe that there are an additional 6,000 physicians who practice some form of Membership Medicine (i.e. Concierge Medical Care or DPC) across the U.S. at this time equating to a total of approximately 12,000 MMCs in the U.S. — representing a total of less than 6% of all licensed primary care physicians in the U.S. (2014). Another way to to look at in perspective, is these 12,000 MMCs represent just over 1% of all licensed physicians in the U.S. across multiple specialties. According to the most accurate observers and news reports in recent past, we caution that exact numbers are hard to come by. But the shift has been gradual, as has the positive data coming out of the MMC marketplace and use and acceptance by consumers.

“We believe — and this is after years of verifying doctors, talking with actual doctors, talking with business leaders, and talking with physicians who are influencers — that there are those physicians who are verifiably, actively practicing some form of Membership Medicine in the U.S., with probably another few thousand practicing under the radar,” Tetreault tells CNBC in an in-depth interview earlier this year. “Many physicians don’t want to draw attention to themselves and prefer keep a low profile.  Right now, far more traditional doctors are telling surveyors that they plan to switch than actually appear to be doing it.”

Concierge practices composed exclusively of concierge patients (most practices include a mix of concierge and traditional patients) generally limit their panels to 600 or fewer patients per physician. Direct Primary Care practices, because they charge a lower fee, need more patients on their rosters and can typically have about 700-1000 patients, according an analysis by Medscape in May of 2014. As the writer of the Medscape articles adds, ‘The distinctions between concierge medicine, private medicine, and direct primary care may be ultimately meaningless, since some doctors call themselves whatever they feel sounds better, and there are so many practice variations, many overlapping, that it often isn’t clear which is which.’

Dr. Cory Annis, an Internal Medicine and Pediatrics physician who recently transitioned her practice from fee-for-service to Direct Primary Care who spoke recently (Summer 2015) at a Direct-Pay Medicine panel at the Pri-Med Southwest Conference in Houston, TX, said the name “Direct Primary Care” doesn’t do justice to the concept or explain it very well to patients. She makes an analogy between DPC and Community Supported Agriculture (CSA), where consumers purchase “memberships” in farms and receive a share of fruits and vegetables in return. She also uses the term “Blue Collar Concierge” to describe DPC to her patients. Read this full interview here.

Until a certification program becomes more widespread, these numbers will continue to be approximations. Given these variables, modern-day variations in the business models and the ill-defined nature of these healthcare categories defined within MMC, it is impossible to calculate an exact number. However, these figures were assimiliated from 2007-2015 and come from the largest database of Membership Medicine physicians and clinics which has been assembled by The Concierge Medicine Research Collective, a geo-coded Masterfile database which began in 2007. This Masterfile database is an accumulation of industry interviews from expert sources; prominent medical school university surveys (2009-2015); as well as a manual “count” of the DPC Clinics operating currently in 2013-2015.

encore career9If we are going to continue to move the needle forward in DPC, villainizing Concierge Care and/OR comparing your business to it will not accomplish the task at-hand. Concierge Medicine is not bad. Patients love it. And, they’ll love DPC … if you do as well … but brand it your own in your local community!

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According to Dr. Samir Qamar, M.D. is CEO of MedLion Direct Primary Care, and President of MedWand telemedicine devices, he writes … “Direct Primary Care’s definition, therefore, is any primary care practice model that is directly reimbursed by the consumer for both access and primary medical care, and which does not accept or bill third party payers.

Confusion arises from similarities that exist in both models, such as decreased patient panels, monthly subscriptions, and longer visits. There is added confusion when a DPC physician offers house calls or email access, typical of concierge practices. Confusion is maximized when a physician is by definition practicing direct primary care, yet calls the practice a “concierge practice.” Similarly, a concierge practice may decide to abstain from participating in third party payer systems, and thus would also be a DPC practice.

The distinction is important because Direct Primary Care is explicitly mentioned in the Affordable Care Act, while concierge medicine is not. Several state laws have also recognized Direct Primary Care as medical practice models, and non-insurance entities. In addition, the term “concierge medicine” causes visceral reactions in select social and medical circles, drawing criticism such as elitism and exacerbation of physician shortage.

In summary, not all Direct Primary Care practices are concierge practices, and not all concierge practices are Direct Primary Care practices. The terms are not synonymous, and even the basic fundamentals of either model do not overlap. The key to differentiation is whether or not a third party payer is involved. If not, then the model is a direct pay, or Direct Primary Care model, no matter what the fees.”

Although there are currently less than 300 identified or ‘branded’ DPC Clinics in the United States alone, they continue to be an almost underground success. With all the changes in medicine today and the increasing move toward value, DPC is a definite and increasingly valuable part of the answer to decreasing cost and improving quality, particularly in primary care and family medicine. Although predicting the future is difficult, it looks bright for the new sector of DPC Medicine.

Jim Eischen, Esq., said it best this past April 2015 at a physician meeting in Phoenix, Arizona when he said from the podium …’let’s focus on substance, not labels.'”

Source: The Direct Primary Care Journal, 2015, June 1.

~Michael Tetreault, Editor, The DPC Journal, Concierge Medicine Today 

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Categorised in: Business, DPC News, Marketing, National Acceptance, National News, Politics and Wash. Policy, Research, Resources, Trends

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