Will direct primary care bring joy back to medicine

More than half of physicians report at least one symptom of burnout. This is much higher than in the general population.

The major factors of physician satisfaction involve perceived obstacles to providing high-quality care such as unsupportive practice leadership or insurers refusing to cover medically necessary services.

In particular, primary care physicians are frustrated when regulatory demands limit the time they can spend with each patient. It would take primary care physicians 21.7 hours per day to provide all the recommended preventive screenings and chronic disease care for a standard patient panel.

It is no wonder that very dissatisfied doctors either reduce their work time or leave medicine altogether. Others are embracing a new practice model.

Researchers at The Graham Center reviewed an emerging practice model by primary care physicians in the United States believed to improve patient access, quality of care through longer visits, and lower overhead costs.

This descriptive study examined characteristics of direct primary care practices and costs for this care. The practices all charge a periodic fee for access. Some practices charge an enrollment fee; others charge a fee for each in-person visit.

Costs are kept low by not billing through insurance companies, which reduces the need for administrative staff and time spent on documentation to justify charges. In this model, physicians can see fewer patients to make a decent living. They can spend more time in direct patient care and counseling. They can provide care over the phone or by email and not worry about reimbursement. Patients are likely to appreciate longer visits and flexible access with a regular provider. This practice model could restore physicians’ joy in the practice of medicine.

Most direct primary care practices are small and new so data on quality are lacking. The two most mature practices, Access Health Care and Qliance, demonstrate that utilization of comprehensive primary care decreased demand for specialty and emergency services. More time and data are needed to study the quality of direct primary care.

Critics of this model are concerned how people who are too poor to afford the regular fees and visit fees could access this care. In 2014, Qliance contracted to care for 15,000 new Medicaid patients. Time will tell how well this model works for this population.

In brief, this is an innovative new model reinvigorating primary care that warrants further research to assess whether it lives up its promises.

commentary by Bich-May Nguyen

Abstract

Direct primary care (DPC) is an emerging practice alternative that (1) eliminates traditional third-party fee-for-service billing and (2) charges patients a periodic fee for primary care services. We describe the DPC model by identifying DPC practices across the United States; distinguish it from other practice arrangements, such as the “concierge” practice; and describe the model’s pricing using data compiled from existing DPC practices across the United States. Lower price points and a broad distribution of DPC practices were confirmed, but data about quality are lacking. PMID: 26546656

Eskew PM. J & Klink, K. Am Board Fam Med. 2015; 28(6): 793-801