The American Academy of Family Physicians understands that in the undulating landscape of healthcare policy in America, the opportunity to spend more time interacting with patients while also providing ongoing follow-up services, is at the heart of the patient-centered care that our doctors want to provide. Many feel existing payment models do not provide the opportunity to focus on the kind of attention that is at the core of preventative medicine and wellness routines.
As a result The AAFP provides practitioners with detailed explanations and tool kits aimed at creating a larger conceptual and cultural understanding of Direct Primary Care.
The following excerpts are from the AAFP tool kit, aimed at physicians. They serve well to illustrate the potential benefits of bringing DPC into your organization.
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What is direct primary care?
Direct primary care (DPC) is a subset model of the retainer-based practice framework for primary care practices. There is not a single DPC practice model; rather the model represents a broad array of practice arrangements that share a common set of characteristics. Perhaps the defining characteristic of DPC practices is that they offer patients the full range of comprehensive primary services, including routine care, regular checkups, preventive care, and care coordination in exchange for a flat, recurring retainer fee that is typically billed to patients on a monthly basis. DPC practices are distinguished from other retainer-based care models, such as concierge care, by lower retainer fees, which cover at least a portion of primary care services provided in the DPC practice.
The practice retainer fee is a set recurring charge billed directly to patients to cover the comprehensive and coordinated primary care services provided by the DPC physicians and practice staff under the terms of a practice retainer or membership contract. The value of the practice retainer fees is most commonly based on the breadth of primary care services covered under the retainer contract.
The intent of the retainer fee structure in the DPC model is to ensure that family physicians are appropriately paid for the entire range of value-added services they provide for their patients. In the current fee-for-service (FFS) payment system, nearly 50% of a family physician’s workday is spent outside of face-to-face visits, often in conducting vital follow-up or helping to coordinate care for patients as they communicate with other clinical providers. Under FFS, these critical non-face-to-face services often go uncompensated. Under a DPC retainer fee, the practice can ensure that family physicians are appropriately compensated for providing comprehensive care, and not just the care provided during an office visit.
The opportunity to spend more time interacting with patients and providing ongoing follow-up services is at the heart of the patient-centered care provided in DPC practice settings. The regular and recurring revenue generated by the practice retainer fees allows physicians participating in DPC practices to overcome some of the pressures associated with the traditional FFS payment system. Because DPC physicians are no longer generating revenue solely on the basis of how many patients they see per day, many report that they have significantly more time to spend with patients in face-to-face visits. Additionally, many DPC physicians provide a larger array of non-face-to-face services, such as tele-visits or e-visits, for their patients, to ensure primary care services can be accessed in a manner most convenient for patients and their families.
The variance between DPC practices is often found in the breadth of primary care services covered by their retainer contract fee structure. Some DPC practices have retainer fees that cover the entirety of primary care services, including care management and care coordination, as well as services involving external organizations such as off-site diagnostic facilities. This means that patients do not have to pay out of pocket for any services delivered to them through their DPC practice beyond the monthly retainer fee. Other DPC practices cover a far more limited scope of services and collect service fees from patients at the time of care to cover costs occurred in the visits. This is because these DPC practices continue to participate in traditional FFS contracts with third-party insurance carriers but utilize the retainer fees to supplement their contracts. Typically, these retainer fee structures only cover services that would otherwise go unreimbursed under those insurance network contracts.