Traditional primary care is failing, and physicians are burning out at a high rate for two main reasons: Insurance payments in fee-for-service practice do not reimburse primary care well, forcing physicians to care for large numbers of patients; and the work of primary care has become more complex, with comprehensive prevention and chronic illness management in an aging society, such that brief visits are no longer effective.
Related: The rise of direct primary care
Garrison Bliss, MD, a general internist in Seattle, Washington is a forefather of concierge medicine. Concierge practice, with a very small patient panel and a high cost to patients—generally more than $1,500 per year—became popular in the previous decade with primary care physicians wanting to get off the treadmill of traditional practice. But concierge practice has limited potential in most communities due to its high cost.
Further reading: Combating the impending physicians shortage
Recognizing this, Bliss turned his interest to founding “direct primary care.” Here, the patient pays a monthly fee—typically about $75—for all the services provided in a primary care practice. The primary care physician can do well financially with panels of patients of 1,000 or fewer. More time and attention can be given to meeting the needs of each patient. The physician and patients are much happier, and the model is affordable for more of the population.
A variation on direct primary care’s global fee is a hybrid payment model. Patients pay a “membership fee” of about $50 per month for all non-visit services such as online communication, telephone visits and better care coordination and then the patient’s insurance is billed for visits. This combination pays enough for physicians to employ team members to help with patient care, such as physician assistants, nurse practitioners, heath coaches and more activated medical assistants doing more advanced care coordination such as tracking referrals. Patient visits are longer, typically 30 to 60 minutes for routine new and follow-up care.