The direct primary care (“DPC”) model gives physicians (and related professionals such as physician’s assistants or nurse practitioners) an alternative to insurance billing. In this model, the medical professional charges a monthly, quarterly, or annual fee (i.e., a retainer) that covers all or most primary care services such as clinical consultations, labs, and related services.  Generally, it is recommended that patients also maintain a high-deductible plan for emergency situations that fall outside the scope of a DPC model.

The direct primary care model allows patients to maintain substantial savings, know the costs of care and have direct access to a physician.  Of course, the benefits and limitations of the service would be determined by a contract between the patient and the physician.

The direct primary care model was the original model for which physicians would build their practices before health insurance was created.  Rather ironically, the direct primary care model is questioned by “big healthcare” and is generally a foreign concept to the American patient population.

Direct primary care rewards practitioners for caring for the whole person while reducing the overhead and hassle with working with the fee-for-service, third-party-payer billing. Some benefits to practitioners include:

  • Decreased practice overhead
  • Fewer medical errors / less exposure to risk
  • Improved practice collections rates
  • More time with patients
  • Reduced patient volume
  • No time spent on insurance paperwork, appeals or pointless administrative shenanigans
From a legal perspective, a direct primary care model, should at a minimum consider:
-Compliance with local insurance laws to confirm the DPC model is not “insurance”
-Patient/Physician Consent/Intake form
-HIPAA consent form
-Legal entity for liability protection and potential tax savings

If you are planning to start a direct primary care medicine model medical practice, consult with a healthcare attorney who understands the various legal issues and can explain them in plain English for you to understand.

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