Type of Payment

(Jen Lobert) #1

I am new to this site. Wondering if the concept of DPC means cashed based, or membership based only? Are there some structured to pay cash per visit or are DPCs only membership based?

(Jason Larsen) #2

Welcome, Jen!

I’m not the expert on DPC as a whole, but my understanding is that generally the term “Direct Primary Care” refers to a model where the patient and physician have a direct relationship with one another.

While this ‘could’ mean cash-based, “Direct Primary Care” is more commonly being associated with membership-based practices.

Running a DPC practice ourselves, I have introduced our model as “membership-based family medicine” and said that if they “google direct primary care” they will find similar practices to ours around the country.

Although that’s not a crystal clear answer - I hope that helps!

(Dr. Peter Lehmann) #3

Hi @lobertjd,

You should talk with Dr. Brian Forrest of AccessHealthcare in Apex, North Carolina. Access Health Care

His model is largely DPC with “a la carte” pricing for patients who don’t want a membership. The prices for “a la carte” items (office visit, labs) come very close to a yearly membership for most problems. His memberships are not expensive and he charges $20 per in office visit. His is more complicated than I use, but he is one of the earliest pioneers of DPC and he’s tried lots of different models over time.

(Jack Forbush, DO) #4

The generally agreed upon definition comes from http://www.dpcfrontier.com/defined/

(Richard R. Samuel, MD ) #5

“Direct” to me means any physician-patient professional arrangement where there is no insurance middleman. A cash-only practice was where I started in direct care 13 years ago. I changed to a membership model in 2013 to improve continuity of patient care…RRS

(Dr Rob Lamberts) #6

Agree with the above, but I do say that most of us don’t give the option for single visits, as it would undermine people’s motivation to pay monthly and it greatly complicates the access to online communication, which is the cornerstone of what we do. I resisted the temptation because it lowers the quality of care by limiting it to the office.

(Jen Lobert) #7

Thank you for the advice! So helpful.

(Brianna Wilson) #8

In general from watching a lot of the DPC nuts and bolts on YouTube…you may want to consider a “membership” based as then you have reliable income and the costs of care are spread over the year making it affordable for patients. The key is educating patients on the value of membership. Also getting into small businesses

However you need to gauge your community needs. I live in a heavy tourist destination so I will be doing “membership” for my main patients (including a pain specialty membership) but offer an a la cart for walk-ins including DOT exams and sports physicals and be open half days on weekends. Working on my schedule still as I work full time a hospital while starting from scratch.

As an a la carte you might need to see “more” patients and have a pretty heavy schedule similar to the traditional model but in the membership model its more predictable.


(Robin Dickinson) #9

I agree you need to base it on what your community needs…but also think about what you are providing and how that will work. If you are going to provide texting, longer phone calls, etc, you’ll want to get paid for that somehow. I like how the membership model frees me from thinking about money (“I need to make them come in for that rash or I won’t get paid”) and instead think about what makes sense (“It’s Thanksgiving weekend and neither the patient nor I feels like meeting at my office for a mere rash that is treatable by photo.”)

(Brianna Wilson) #10

I have another question about structure.

I need to “keep” medicare a little while longer due to my current job and moonlighting but im wondering something.

In the newer DPC youtube videos they mention the discosure that patients can sign to not disclose their insurance (cant seem to locate he form). Cant I do this with all patients and then charge Medicare patients my walk in fee of $50 along woth a consent for treatment and for them not to pursue reimbursement? One of my moonlighting jobs is at a convenience walk in that doesn’t accept any insurance and charges $50/visit and they only do simple things…i never thought about medicare there and i don’t think they’ve had any issues nor does the clinic manager (a pharmacist) likely know anything about opting out.

If i dont have them as members isnt this a viable option and i wouldnt have to opt out?

-Brianna, DNP, ARNP