What is Direct Primary Care?

Direct Primary Care Explained

Direct Primary Care (DPC for short) is primary care offered directly by primary care physicians (pediatricians, internists, family physicians) to consumers without the need of insurance. The model completely eliminates financial burdens physicians deal with when interacting with insurance carriers. Insurance co-pays, deductibles, co-insurance, billing and coding fees,  collection fees, account receivables, and low reimbursement are just some of the financial burdens that are eliminated as a result of implementing the model. The model is  overall very beneficial to both patients and physicians.

Direct Primary Care Benefits

Physician Benefits

Today’s primary care physician (pediatrician, internist, family practitioner) is facing multiple challenges. Decreasing reimbursement from insurance companies and Medicare, increasing regulations, excessive paperwork, and rising overhead expenses (malpractice insurance, billing, coding, collections, EMR / EHR systems) are challenges that are threatening the doctor-patient relationship. Direct primary care physician benefits include:

  • Paid on a per member per month basis
  • Removes all the expenses for coding and billing
  • Eliminates account receivables (AR), collections, and speeds up the revenue cycle
  • Reduced paperwork
  • No interference from insurance companies
  • Continuous cash flow (revenue stream)

Patient Benefits

In today’s society, more than 30 million  Americans are considered to be uninsured or underinsured. High cost and largely discriminatory policies of health insurance companies has prevented these individuals from getting access to medical care. Direct primary care takes away the need for high cost/discriminatory health plans and gives patients  direct access to the medical care that they need.  Specific patient benefits are:

  • Full access to medical care for all Americans and residents
  • Protects the “Doctor-patient relationship”
  • No barriers to care  – no being told by a third-party (insurance company) you can not have certain treatments or procedures
  • More time spent with your physician – unhurried appointments
  • 24/7 phone, fax, and e-mail access
  • No co-pays, no deductibles, no co-insurance
  • No limit on visits
  • No prior authorizations required

Financial Benefits

Physicians and medical groups today are facing many financial burdens. These  include low reimbursement from insurance companies, Medicare and Medicaid, denial of claims,  downcoding of claims,  high amounts of account receivables (AR), and  high billing and coding fees. These financial woes are common throughout the current Fee-For-Service (FFS) system and are causing severe harm to physicians and medical groups’ bottom lines. These woes will only continue to get worse as insurance companies try to protect their shareholder/ corporate  profits.

The direct primary care model is the best antidote for these financial woes. Direct primary care models specifically pays physicians on a per patient per month basis (provides higher revenue per month), 100% of patient payment goes directly to the physician (0% goes to the pockets of insurance company executives),  eliminates contracts with insurance companies, eliminates billing and coding (eliminates all expenses associated with billing and coding), and eliminates account receivables (no more debt produced by patients and slow paying insurance companies). If you like what you hear, considering switching and make sure to check out Medical Access USA’s direct primary care model.