Direct Primary Care (DPC) vs. Traditional Primary Care

When was the last time you went to the doctor? If you’re among the 77% of Americans who have a primary care physician, your experience likely included calling a clinic, booking an appointment (probably days later), sitting in a waiting room for what would eventually be a 16-minute visit with your doctor. Is it any wonder that fewer young Americans and those without complex medical conditions are less likely to have an identified primary care physician or even go to one (even when they have one)?

The example above is the typical experience in a primary care setting today. Lots of waiting for what is often a brief exchange with a doctor. (We spend more time in the Starbucks line.)

The U.S. traditional primary care model is ruled by medical claims and ICD-10 codes, the complicated coding system used by health care systems to classify procedures and treatments so that they can ultimately get paid (reimbursed). When about half a doctor’s day is spent typing notes (and not patient care), should we be surprised to see so many doctors leave the traditional primary care practice to go to newer models that close the door on the complicated claims work?

Enter Direct Primary Care, a type of subscription model for primary care that says “goodbye” to all the paperwork mess (and pretty much anything to do with insurance companies).

What is primary care?

Primary care is generalist medical care. Primary care physicians (PCPs) are proficient at a lot of medical ailments and the majority of healthcare needs for the average person. They are the hub of the wheel guiding the patient to a specialist (spoke) if more care is needed. By establishing a medical “home” with a PCP, the hope is that you address issues earlier on (to prevent them from getting worse or untreatable) and that you avoid any unnecessary visits to an ER (which means $$$.)

Ideally, this is how it would work. You have a terrible fever and cough. It could be a cold but it could be something else. You check in with a doctor, are able to see her that morning in-person or virtually. She’s worried it’s strep orders a rapid test and it’s confirmed. Antibiotics are prescribed and you’re back to feeling your old self in 24-hours. Did I mention the visit was free??

But, if seeing your PCP is inconvenient and expensive instead you might deal with it until it gets so bad you end at the urgent care center. Or ER. Surprise, surprise – the number of urgent care centers has doubled since 2014 and the number of freestanding ERs has shot up in the last two decades, Texas alone has more than 200.

Why does primary care matter?

The average cost of treating nonemergency conditions (such as bronchitis, sore throat, and the flu) in the ER is more than $2,000. That’s about $1,800 more than treating the same conditions in a primary care setting. Even if you had health insurance, there is often a very high deductible or large co-pay difference, like several hundreds of dollars, between primary care services and an ER visit. And all you had was strep throat.

Let’s not forget the time. An ER average wait time can be as high as three hours depending on where you live.

And when 1 in 10 persons owes medical debt, there are a lot of good reasons to focus great healthcare around primary care.

What’s traditional primary care?

“Traditional” primary is what we consider the typical primary care experience today. But that hasn’t always been the case. Claims specialists, clinical coders, medical scribes, prior authorization managers — these are all healthcare jobs established within the last three decades as electronic medical records became the standard. And with it a new, more cumbersome provider payment process.  

Here’s how typical healthcare reimbursement works:

1. Patient case is documented in an electronic medical record and assigned codes to each treatment, diagnosis and/or procedure. This makes up the claims.
2. Claim is submitted electronically through a clearinghouse or other third-party reviewer to make sure it’s accurate.
3. The claim is interpreted by the payer and either accepted or rejected.
4. If accepted, a payment is sent to the provider and invoice to the patient.

It’s not hard to see why a patient bill often appears many weeks or months after the service rendered. It’s also not hard to understand why health care administration costs have ballooned. And none of this is actual care delivery.

What’s Direct Primary Care (DPC)?

Imagine not needing any of the processes (or departments) mentioned above. Under the DPC model there are no claims. The doctor gets paid a monthly membership fee to take care of the patient. It’s the kind of healthcare that primary care doctors went to medical school for – unencumbered patient care.

There are also a lot of other benefits with direct primary care services:

• Unlimited appointments at no additional cost
• Built-in telemedicine, including phone, text, and video visits
• Same-day and next-day appointments
• Help with coordinating health needs outside of primary care like imaging, specialists, etc.
• Longer appointments (basically more time and attention)
  
  

This type of care is what primary care used to be like — in those days when everyone knew the local doctor’s name, where she’d occasionally make house calls or proactively phone just to check in. It’s a big reason why we’re seeing patients shift to this type of care — with DPCs reporting a 240% increase in patient membership in just four years.

Ever feel rushed at the doctor’s office? It’s not you. The average patient panel size for a traditional primary care physician is 2,300 patients in one year. That’s eye-opening when you compare that patient panel size for a direct primary care provider — 200-600. How can a doctor-patient relationship be established when you have to see 20 patients a day and do up to four of admin work?

Subscription models of care is also catching wind from other industries like Amazon.

If Direct Primary Care doesn’t accept insurance, how does Decent do it?

All of this sounds great until you discover that most DPCs don’t take health insurance. It means that many who choose a Direct Primary Care provider for all the benefits mentioned above also need to pay for at minimum a catastrophic health insurance plan to insure them in case of an unexpected hospitalization.  

Unless you’re a DPC in Texas.

Decent’s health plans for small businesses center around Direct Primary Care. It means it’s not too good to be true, it is true. Because we pay Direct Primary Care providers like they want to be paid – a monthly fee for each patient — they are excited to partner. DPCs want their patients to be insured, they just want to also provide unencumbered care.  With Decent, there is still no claims, no need for scribes or coders.

Decent believes the best primary care is where nothing gets in between the patient and provider. And because patients with DPCs communicate with their doctor more often, they are less likely to visit an ER or urgent care center for a non-emergency issue. It’s a win-win for everyone.

Curious about Decent’s health plan? Learn more about direct primary care with Decent by clicking here or contact us at support@decent.com

‍