Monday, September 9, 2013

Guest Post: Why the Direct Primary Care Model would benefit poor patients (2 of 2)

This is the second of two guest posts by Dr. Marguerite Duane. Part 1 is posted here.


What about specialty care? In the Direct Primary Care model, physicians have more time to spend with their patients to diagnose and treat problems appropriately; therefore, specialist and emergency visits, surgeries and hospitalizations are all significantly reduced. Also, specialists are willing to reduce their fees when they are guaranteed timely payments without insurance processing delays.

So, if direct pay models could provide affordable, personalized primary care for the poor, why are more physicians and/or practices in underserved communities not moving to this model? I think there are two main reasons:

1. Physicians may mistakenly believe that poor people can’t afford direct primary care because they do not appreciate that these models are different from concierge medicine. Concierge medicine usually involves cost-prohibitive retainer or membership fees that guarantee 24-hour physician access. However, these fees often do not cover actual physician visits, which may still be billed separately. On the other hand, monthly membership fees in direct pay models of primary care are far more affordable, typically costing less than a monthly cell phone bill. More importantly, these fees cover physician visits.

2. It may be difficult for patients and physicians to move to direct pay models of care because they are trapped in the current insurance model. Physicians are accustomed to being paid by insurance companies, so they provide and document the "care" that insurance companies require in order to be reimbursed appropriately, rather than the care that patient actually needs. Many poor patients are accustomed to being covered by Medicaid which allows them to access care without co-payments, so in their mind it is “free.” However, since fewer and fewer physicians accept Medicaid, patients “spend” a lot of time and effort just searching for care rather than receiving the care they need. While change is difficult, physicians and patients alike must move beyond their dependence on health insurance for primary care, because with the insurance company as the payor, the patient will never really be at the center of care.

Patients who pay for primary care through direct pay models can choose physicians who provide high quality, satisfying care. The smaller patient panel sizes facilitated by this model of care make it possible for physicians to form stronger relationships with patients who benefit from the extra time and attention.

Insurance is designed to cover unpredictable, undesirable or expensive events. Primary care is none of these. In my view, Direct Pay practices are viable primary care options for patients of all income levels.


  1. Finally, an explanation of Direct Primary Care (DPC) worth paying attention to. Dr. Duane smartly educates the reader of the differences between DPC and concierge medicine (and they are absolutely different), understands the barriers to its growth, and is spot on when defining DPC relative to health insurance.

    MedLion Direct Primary Care, the fastest growing DPC company in the country, was specifically started to care for the underinsured. MedLion is family-physician owned, and has not accepted any investors so not to dilute its mission to increase access to quality primary care. Dr. Duane would be happy to know MedLion has already spread the DPC model into small rural towns in Arizona and Nevada, in addition to many metro areas. Dr. Duane is correct - the DPC model applies to everyone.

  2. This article very much covers the reality that we are seeing being present among all doctors and hospitals. For the first time in years we are facing a true scarcity of doctors within primary field. We are also seeing a huge rise of DPC. The future is now and unless we see big changes in medicine the rise will continue. I recently wrote article that is very much in line of this discussion that I wanted to share with readers. Dr. Ian Kroes, Concierge Medical Doctor at Peninsula Doctor