Nationally, direct primary care practice is considerably newer than concierge practice — and there are considerably fewer direct primary care than concierge physicians. Michael Tetreault is Editor in Chief of 2 online journals: Concierge Medicine Today and The Direct Primary Care Journal and estimates that direct primary care physicians make up about 20% of the retainer medicine movement right now; the other 80% are concierge physicians.*
“Generally, direct primary care is a cash-only practice,” he says. “However, although we have no hard data, we estimate that less than 20% of direct primary care practices accept insurance. So there are some that do.”
Direct primary care physicians charge less than private or concierge physicians: “from $25 to less than $100 a month,” Tetreault says. “We believe that these fees represent about 90% of the direct primary care physician community.”
That fees are payable by the month rather than by the quarter or year is important to many direct primary care patients, who may have cash flow problems in a tight job market. “That’s a big difference,” Tetreault says, “no long-term contract.”
Direct primary care practices may or may not offer same-day appointments. Most probably don’t, Tetreault says. The doctors probably won’t give out their cell phone numbers, meet patients in the ER if they have a late-night crisis, or make house calls — although some direct primary care doctors do make house calls, he adds.
If house calls are offered, they are typically billed separately, not included as part of the monthly fee. Flu shots and vaccinations are usually billed separately too.
Direct primary care (DPC) is an emerging model that has gained some attention nationally in recent years. Sometimes referred to as ”retainer practices,” DPC practices generally do not accept health insurance, instead serving patients in exchange for a recurring monthly fee — usually $50 to $80 — for a defined set of clinical services.
“Many direct primary care practices do not build in concierge medicine service components, such as 24/7 care, cell phone text messaging, and instant or same-day appointments,” Tetreault says. “And yet, some do.”
Concierge practices composed exclusively of concierge patients (most practices include a mix of concierge and traditional patients) generally limit their panels to 600 or fewer patients per physician. “Direct primary care practices, because they charge a lower fee, need more patients on their rosters,” Tetreault explains. “They typically have under 1000 patients.”
The distinctions between concierge medicine, private medicine, and direct primary care may be ultimately meaningless, since some doctors call themselves whatever they feel sounds better, and there are so many practice variations, many overlapping, that it often isn’t clear which is which.*
Still confused by this semantic hair-splitting? Join the club. Even concierge and direct primary care physicians may be confused about which type of doctor they are.*
“In polls, we’re asking the actual physicians, ‘Do you consider yourself a concierge doctor or a direct primary care doctor, or do you consider yourself both?’” Michael Tetreault, the journal editor, says. “Most say that they consider themselves a concierge doctor. But they still don’t understand the differences. A lot of doctors consider themselves to be both.”
Collectively, direct primary care (sometimes linked to the term concierge medicine) has more than a half million people on their rolls, according to the California HealthCare Foundation. They highlighted five large direct pay practices that use the retainer model in an April 2013 report. These direct primary care patient rosters are estimations:
- Iora Health, with 2,400 patients
- MedLion, with 3,000 patients
- Paladina Health, with 8,000 patients
- Qliance, with 7,200 patients
- White Glove Health, with 40,000 patients via self-insured employers and 450,000 via health plans
Direct primary care providers help keep costs low by avoiding unnecessary referrals and by referring mainly to specialists willing to offer significant discounts. Despite this advantage, the DPC model may be hampered by low awareness among health plans and primary care physicians, resistance from some insurers, and resistance from competing hospitals and specialists.