by: Rob Lamberts, MD – Nov 6, 2018
There are two big differences between a traditional and a direct primary care (DPC) practice:
- The doctor is paid directly by patients, not insurance (or other third-parties)
- The patient doesn’t pay for office visits, instead paying a low monthly fee (typically about $50 per month).
The monthly payment is enabled by the freedom from insurance billing and codes, so the two changes are tied closely together. This article will focus on the ways in which the monthly payment changes the experience for doctors and patients.
First, I want to address certain hybrid practice models and their use of monthly fees. Many “concierge” practices (and even some who label themselves DPC) use the monthly fee in addition to traditional insurance billing. This practice can only legally be done if the monthly fees are for “uncovered services,” those not covered by third party billing codes. While this does give the opportunity for significantly increased revenue, it also increases the risk of double-billing for a single service, which has especially bad repercussions if Medicare or Medicaid are the payer. For those who are considering this approach, I recommend doing so with great care and close counsel from experts. people/companies with significant experience doing this….