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Analysis: Direct Primary Care in the United States

Posted by William Kirkpatrick on Aug 29, 2016

Medical-Records-Management.jpgIn an study published last week entitled, “Direct Primary Care: Practice Distribution and Cost Across the Nation,” Philip Eskew, DO, JD, MBA and Kathleen Klink, MD, document, research and analyze Concierge Medical Practices and Direct Primary Care (DPC) practices spanning across the United States. Topics include: the stigma associated with the term "concierge," a distinction between the various healthcare models, an explanation of why DPC is growing in today’s medical world, and an an analysis of how it meets the basic desires of both physicians and patients and how it is priced across the U.S. 

Definition: Direct Primary Care

The definition of DPC is a primary care practice that charges a periodic fee for services, does not bill any third parties, and any per-visit charges are less than the monthly equivalent of the periodic fee. 

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. The defining characteristic of DPC practices is that they offer patients the full range of comprehensive primary services, which include routine care, regular checkups, preventive care, and care coordination in exchange for a flat, recurring retainer fee that is billed to patients on a monthly basis.

Direct Primary Care vs Concierge Care 

Although DPC and concierge care belong to the same family, concierge medicine is a term that embraces many different health care models, including DPC. 

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. 

DPC practices, like concierge practices, remove many of the financial barriers involved such as insurance co-pays, deductibles or co-insurance fees. DPC practices take a low, flat rate fee and do not accept insurance payments; thus, avoiding the administrative overhead involved with with insurers. On the other hand, concierge practices usually charge an annual retainer fee and promise more “access” to the doctor. 

Why Is Direct Primary Care Growing?

The direct primary care model is growing steadily due to economic and legal pressures on physicians. Many physicians say keeping up with the paperwork involved in value-based care, meaningful use of electronic health records (EHR) and other initiatives tied to the Affordable Care Act, leaves little time to actually practice medicine.

With DPC practices, many doctors see much lower operating costs than traditional primary care practices because there is no need to send claims to third-party payers. Thus, the retainer fee payment structure makes the operations simpler.

Furthermore, DPC can help improve the work-life balance of the physician. Paperwork often keeps doctors working long hours but DPC reduces the paperwork and helps physicians better balance their lives outside of work. 

For patients, DPC provides a beneficial alternative for those seeking more personal, proactive, and/or intensive medical care. Because of the DPC contract, patients gain more access to their doctor with greater ease. This means that they can get the care that they need. 

Physician Explaination

Physicians specify three key improvements to their practice after transitioning to the DPC model; (1) increased availability and, therefore, access; (2) more time for each patient encounter, leading to improved quality; and (3) lower overhead costs. Without insurance paperwork to fill out, there is far less need for office staff, and therefore less overhead for payroll. By abandoning third-party fee-for-service billing, the DPC model reduces overhead by more than 40%, which results in lower costs for patients. Low overhead allows providers to have small patient panels, giving patients better access and allowing more time per visit.

Physicians carry a panel of about 800 patients—about one-third the panel size in a typical practice. Patients can get office visits that last thirty to sixty minutes, any day of the week, plus phone appointments, e-mail communications, and twenty-four-hour telephone access to a physician on call. In a typical day, a physician sees about ten patients, handles three to ten phone calls, and interacts with one to five patients via e-mail. With smaller panels, providers have the time not only to provide urgent care, annual physicals, and wellness counseling but also to coordinate specialist and hospital care and to manage chronic diseases.

The direct care patient medical home model, with its smaller patient panels, ample time per visit, competitive pay, and manageable lifestyle, has the potential to reignite excitement among those considering a career in primary care. 

Patient Explantion

DPC is offered at reasonable pricing to the patient due to the abandonment of third-party fee-for-service overhead. Patients get more minutes, and are charged less leading to more favorable outcomes. 

Patients experience 35% fewer hospitalizations, 65% fewer emergency department visits, 66% fewer specialist visits, and 82% fewer surgeries than similar populations.

The Cost of DPC In The U.S.

Of the 116 practices analyzed in the report, the average monthly cost to the patient was $93.26.

Practices that used the phrase direct primary care on average charged a $77.38 monthly fee while practices that used the term concierge to describe their model charged a $182.76 fee.

The study found the public perception of the term concierge as having higher prices holds true. Self- described DPC practices charged a lower average monthly fee of $77.38 compared to DPC practices that self-described as concierge, which charged a month fee of $182.76.


Direct primary care in the U.S. is affordable. Patients benefit from greater physician access and are charged less. Physicians are able to maintain close relationships with their patients and also have more control over their personal lives without lowering their income.

Patients enrolled in a DPC practice experience a 50% reduction in emergency department visits, specialist visits, advance radiologic testing, and surgical procedures than those enrolled in traditional practices. The only measure of increase is the number of primary care visits, which more than doubled from an average of 2 to an average of 4 per year during the reporting period. Even though patients of DPC practices visit their DPC physician more often, they stay out of the emergency room more often than patients of traditional care practices.

As the utilization of low-cost comprehensive primary care increases, the need for high-cost emergency and specialty services decreases. 

If a free meet and greet with a direct primary care physician interests you than schedule an appointment today. 

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(1) Eskew, Philip M., and Klink Kathleen. "Direct Primary Care: Practice Distribution and Cost across the Nation." Direct Primary Care Practices in the United States, pp. 793-801.

(2) Concierge medicine: legal issues, ethical dilemmas, and policy challenges, Portman.

(3) Page L. The rise and further rise of concierge medicine

(4) Forrest B. Breaking even on four visits per day. Fam Pract Manag 2007;14:19–24. 

(5) Bliss G, Bliss E. Qliance corporate multi-site DPC model. Presented at the Family Medicine Education Consortium Direct Primary Care Summit, Arlington, VA, June 20, 2014. 

Topics: Direct Primary Care, Physician Shortage, Home Care, Primary Care Today, Healthcare Today