MDNews - San Antonio

MANY PHYSICIANS MAY recall years ago when commercial insurance payers paid a percentage above the CMS Allowable, and Medicare was one of their lowest payers. Today, for many small groups and solo physician offices, Medicare is their best payer. This change has caused physicians to worry about revenue not keeping up with rising expenses. Some primary care physicians in San Antonio are turning to the direct primary care (DPC) model and decreasing their reliance on third-party payers. According to Medical Group Management Association, "Concierge medicine is often confused with the DPC model; however, a key distinction is that DPC is explicitly mentioned in the Affordable Care Act as an acceptable option for receiving medical care without insurance, while concierge medicine is not." Concierge medicine charges a membership fee and bills the "member's" insurance for the medical care provided during the visit. DPC charges an "access" fee and the patient's insurance is not billed for the visit. A DPC patient typically pays $50–$100 per month for unlimited access to the physician and healthcare team. DPC models started in the late 1990s and early 2000s. DPC allows the physician to focus more on the patient visit and emphasize wellness and prevention to keep the patient healthy. Many physicians using the DPC model are pleased to have unlimited time with patients, decreased practice overhead, less exposure to risk, fewer medical errors and zero insurance filing. Because there is no insurance involved, the patient doesn't pay copayments to see the physician. So, what's the difference between a typical family practice and DPC? DPC is a g reat option for patients w it h hig her deductibles; however, a patient should be well informed of the adva ntages a nd disadva ntages of the DPC model before ma k ing a cha nge from traditiona l insura nce. ADVANTAGES OF THE DPC MODEL + B et t er hea lt h out c ome s t h r ou g h better access to physicia ns + Lower, transparent costs based on a flat rate + Enhanced patient experience by cre- ating a relationship between provider a nd patient by offering unrestricted access to treatment across a va riety of platforms + Ava i lable access rega rd less of a ge, pre-existing conditions, insura nce coverage or nature of the illness + Less administrative burden, gener- a lly a llowing for longer interactions LIMITATIONS OF THE DPC MODEL + DPC a g reements do not cover spe- cia lists or hospita l stays + As primary care physicians see fewer patients under the DPC model, access will be limited + Patients with Medicare, Medicaid or ACA pla ns will have limited funds + For practices exclusively of fer ing DPC, their only source of revenue are those patients who receive this ca re Many physicians are able to reduce their patient panel size by changing to the DPC model due to the new expected revenue from the monthly membership fee. Contact Concordis Practice Management LLC at 210-704-1014 if you would like to discuss changing your practice to a DPC model. n Is the Direct Primary Care Model Direct Primary Care vs. Traditional Doctor's Visits FAMILY PRACTICE DIRECT PRIMARY CARE Medical professionals practicing 79,831 1,000 Patients per doctor As many as 2,367, according to some estimates 500–1,000 Cost per visit Depends on insurance plan Free with monthly membership — often about $50 How long a visit is 13–16 minutes 30–60 minutes How doctors get paid Salary — about $207,000 Paid with monthly membership fees Can you use insurance? Yes No Cost of blood tests Depends on insurance plan, typically billed after the fact Wholesale price, often included as part of the exam for free Cost of prescription drugs Copay amount Wholesale price plus 10% BY DINA PETRUTSAS, CPA From Business Insider References: 1. businessinsider.com/direct-primary-care-a-no-insurance-healthcare-model-2017-3 2. mgma.com/data/data-stories/advantages-and-limitations-of-the-direct-primary-c 3. medicaleconomics.com/business/direct-primary-care-three-key-consequences-dropping-payers 4. tafp.org/news/tfp/spring-2015/cover for You? 1 4 1 4❱❱❱❱❱ P R A C T I C E M A N A G E M E N T

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