What is Direct Primary Care (DPC)?
A membership program in which patients pay a monthly or yearly fee instead of paying a copayment at every visit and billing insurance. For this membership fee you can have consistent access to your personal provider.
What does the membership cover?
Routine and urgent office visits Wellness/preventative exams Well child exams, including school and sports physicals (vaccines are at additional cost) After hour visits as needed to prevent urgent care and emergency room visits Basic office tests (urinalysis, strep tests, pregnancy tests, blood pressure checks) Office screening tests (vision screening, hearing screening) Basic in-office procedures (laceration repair, skin lesion excision, cryotherapy, nebulizer treatments, etc.) Same day or next business day appointments Significantly reduced lab costs
What does membership not cover?
Hospitalizations, Emergency Room visits, outside labs, pathology services, cultures, imaging studies (x-rays, CT scans, MRI, ultrasounds, etc.), evaluations by other physicians and specialists, physical therapy, immunizations, and prescription medications.
What is the advantage of DPC?
By limiting the number of patients in the practice, we can give you prompt and personalized care tailored to your needs. You would get same day and next day scheduling with no wait. Extended visits of an hour or more could be scheduled, if you’d like! You will have quality time with your provider, answering all your questions. All this care from a provider that knows your story inside and out.
Is DPC like insurance?
No. You should still carry major medical insurance and consider a health savings account. Health savings accounts may pay for a membership fee. You would need to check with your employer, financial advisor or CPA or lawyer.
Why would a provider consider DPC?
The average provider spends about half their day providing medical care and about half their day doing clerical and administrative tasks such as insurance forms, figuring out complex coding requirements, negotiating with insurance companies over prior approvals and computer work. This problem has been getting worse and we expect will get continue to get worse. All of this additional work takes us away from spending time with patients and our own families. Without the burden of extra work that insurances require, we can work directly with our patients and provide personal, comprehensive care that is best for you.
Can I become a DPC patient if I have Medicare?
No. We have decided to remain Medicare providers. Because of the strict Medicare guidelines, we will continue to bill Medicare and any Medicare replacement and supplemental plan. We will not accept any new Medicare patients. Only existing Medicare patients will be allowed to stay in the practice. Unfortunately, current Medicare guidelines prevent us from offering DPC to Medicare patients. We are hopeful that healthcare changes in legislation will allow this in the future.
I am fairly healthy and I don’t go to the doctor very often. How does this benefit me?
Everyone benefits from health care tailored to their needs. You will get the care you need to optimize your health, conveniently and thoroughly. We would encourage you to come in for a Wellness Visit. Most of us end up get ill or injured and need care. When this happens you will see a provider that knows you and can take this into account when developing a treatment plan. If we can prevent just one ER visit, you will probably save a year or more of membership fees.
Are membership fees tax deductible?
Right now, it is not clear. Please check with your tax consultant. The membership fee may not be a “medical expense”. There is a move in Congress to clarify that these fees are medical expenses.
How do I pay my membership fee?
The fee can be paid monthly, or annually by debit or credit card via electronic charge or by ACH from your checking account on a set day of the month.
What if I need to go to the hospital?
Our hope is that being more available will prevent or reduce hospitalizations. You may go to the hospital of your choice. We will work with your hospital doctors and arrange your follow up after you are discharged. We do not perform hospital care but are happy to be an available to answer any questions your hospital provider may have.
Can I just wait and join when I have a problem?
We suggest you join before the problem arises so we can get to know you. We will only accept a limited number of patients. After we reach our limit, a waitlist will be created. Given our current patient panel, we expect our DPC panel to fill rapidly.
Do patients need to sign an agreement?
Yes. You will be asked to review and sign a Patient Agreement. This is to make sure you understand direct primary and the membership fee. If you have Medicare, you will be billed in the same way as before.
Is Direct Primary Care the same as Concierge Medicine?
These terms are often used interchangeably. However, concierge medicine is more often used as the term for any practice with a membership fee, and especially for a practice that continues to accept insurance and often has much higher fees. Direct primary care is direct - between the patient and the provider. Insurance is not accepted, and the cost is usually quite a bit lower. It is sometimes referred to as concierge for the common person. Boutique and retainer practices are other terms occasionally used.