Is the DPC movement at risk of failing?

May 31, 2017

While the idea of direct payments between patients and physicians seems like a blessing among the healthcare chaos, the recent closures of two leading DPC businesses have put a question mark on the movement’s future.

Between the seemingly never-ending battle with insurance companies and attempting to survive among government mandates, it is no wonder primary care physicians have been gravitating towards direct primary care (DPC).

 

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However, while the idea of direct payments between patients and physicians seems like a blessing among the healthcare chaos, the recent closures of two leading DPC businesses have put a question mark on the movement’s future.

Seen as the pioneer of DPC, Qliance Medical Management of Seattle, Washington, closed its doors in mid-May and plans to officially shut down June 15 after a decade of providing care through monthly membership.

Erika Bliss, MD

Turntable Health in Las Vegas, Nevada, whose founder and CEO is Zubin Damania, MD-also known as the rapper ZDoggMD-closed in January.

“Qliance has been the poster child for DPC,” says Robert Berenson, MD, of the Urban Institute in Washington, D.C. “Everyone was very positive of them. If that one can’t make it … it suggests maybe the business model (of DPC) is flawed.”

What went wrong?

The inability to secure long-term funding was what drove Qliance to shut its doors, says Erika Bliss, MD, co-founder and CEO of the Seattle business.

 

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“We (had been) working on developing a more advanced primary care model under direct primary care, bringing everything all together to make sure all the pieces were together,” she told Medical Economics. “From all the virtual services, patient management, urgent care, office space and in-person care. It all has to be connected.”

But to further expand their DPC model, loans and contracts were needed and ultimately did not happen.

“We tried to figure out if we could scale back enough to hold tight until the contracts went through, but it didn’t work out,” Bliss says.

Adding insult to injury, Bliss said Qliance had to immediately shut down all operations in May due to a debt consolidator illegally withdrawing nearly $200,000 from the company’s account.

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Bliss says she is pursuing legal action, but no matter the outcome, Qliance will not reopen.

But despite Qliance’s failure, Bliss says she remains hopeful that DPC will continue to grow and evolve.

 

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“What I don’t feel positive about is that we are still facing some of the same fundamental problems that we’ve been facing for the past 10, 15, 20 years,” she says.

Many of the struggles Bliss continues to see facing DPC-and that she battled with Qliance-stem from the lack of funding primary care receives from the government.

“We as a country say, primary care is awesome and important, the bedrock of the system, but yet the total amount spent on primary care is so low that it’s insulting, it’s absurd,” she says.

Addressing the specific challenges of female-led DPC practices is also important for the movement to grow, Bliss says.

“We had a lot of naysayers against us when raising money because we were women,” Bliss says. “I was told by multiple people in the industry that women-owned organizations don’t work and (investors) don’t want to support them … this is why we were struggling in the first place and why we needed the loan.”

 

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Nevertheless, Bliss says she is proud of what Qliance accomplished and feels that its closing will only drive DPC forward.

“We were the pioneer on this scale, we stuck our neck real out to get laws passed, the first to do a lot of stuff (for DPC),” she says. “It’s probably the rule, not the exception, that the pioneer gets clobbered.

“I’m proud that Qliance was noisy enough,” Bliss continues. “We got a lot of recognition and it helped shine a spotlight on this model nationwide. Lots more doctors know about it now.”

Can DPC truly be sustainable?

While Bliss says she hopes DPC supporters learn from Qliance’s mistakes to grow the movement, Berenson says he thinks more needs to be done to show the business model can truly be successful long-term for primary care physicians.

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“I’ve been skeptical of the movement,” says Berenson, who also practiced primary care for 20 years. “I don’t understand why the same energy (that’s being used for the DPC movement) hasn’t gone into making insurers change their payment methods and their payment amounts.”

 

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Berenson says he does believe DPC is a good concept, but there is not enough data to show its sustainability, and with the closure of Qliance and Turntable-who did not wish to comment on this story-that doubt remains.

“The sad part is I certainly understand the doctors who want to get off the treadmill, but we already have a shortage of primary care physicians,” he says. “Then we are pulling [physicians] out from the workforce who are catering to healthier people and then that exacerbates the situation we already have.”

Philip Eskew, DO-founder and CEO of Frontier DPC in Cheyenne, Wyoming-says he has concerns that the DPC movement, “appears to be growing at a linear rather than exponential rate,” attributing most of the growth to smaller, standalone practices. But he notes despite the closure of Qliance and Turntable, “greater than 90% of them appear to remain open.”

Eskew adds that his greatest concern is “too few family physicians are willing or interested to practice broad scope family medicine, and too few patients are willing or aware that they should be holding their physicians accountable to this higher standard.”

So, in turn, he notes, patients aren’t making the move to DPC.  

“Too many patients see direct primary care and think, ‘I already have a cardiologist, endocrinologist and neurologist, but I never see my family physician so I would never use DPC,'” Eskew says.

Nonetheless, Eskew notes, that DPC is too diverse to fail on a larger scale.

 

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Bliss agrees and says DPC physicians are still pushing their movement forward in the form of creating their own network without the government’s involvement.

“That’s where this is going,” she says. “Many flowers are blooming and we’re all just starting to talk to each other.”

 

*Editor's Note: We have updated this article to clarifiy Philip Eskew's comments.