Issue link: https://viewer.e-digitaledition.com/i/1312111
CASE STUDIES: DIRECT PRIMARY CARE PIONEERS BY THOMAS CROCKER MOST DPC PR ACTICES charge patients a monthly or annual membership fee that covers extensive access to a physician and a range of services, such as lab work, medi- cation dispensing, urgent care, diagnostic services, minor procedures and health coaching. DPC practices do not accept insurance, but they may advise patients to purchase a policy covering services that fall outside their scope of care. The A merica n Academy of Fa mily Physicia ns suppor ts DPC, a nd DPC proponents argue that it enhances the physician/patient relationship, produces significant cost savings for patients and reduces overhead costs and administra- tive burdens for physicians. DPC does, however, have detractors. In a 2018 op-ed for STAT, Timothy Hoff, PhD, Professor of Management, Health Care Systems and Health Policy at Northeastern University, argued that DPC presents a number of problems, including inherent limitations on scalability. Nevertheless, DPC seems to be growing more popular. From 2010 to 2020, the number of DPC practices in the U.S. surged from a handful to more than 1,000 and counting, according to Josh Umbehr, MD, family medicine physician and cofounder of Atlas MD in Wichita, Kansas, one of the first DPC practices. He believes the COVID-19 pandemic may contribute to further growth. "Post-COVID-19, when many outpa- tient clinics have realized that insurance contracts are not the financial security blanket they thought they once were, I think we may see the direct care model become the standard for outpatient care in the U.S. and abroad," he says. THE TRAILBLAZER D r. Um b e h r c ofo u n d e d A t l a s M D in 2010 two months after completing his residency. He discovered DPC — then largely known as concierge family medi- cine — after working in medical billing and coding for a plastic surgeon as an under- graduate. Disenchanted by that firsthand look at the complexities of insurance billing, Dr. Umbehr resolved to practice affordable, concierge-style medicine. "The problem with fee-for-service care is that patients don't know when they are going to need care, but when they need it, they want it now from someone they know and trust, and they are worried about the price," Dr. Umbehr says. "All of those things are opposed to the fee-for- service model, which is why I think a lot of membership services, including Netflix and Amazon Prime, are so successful. People want maximum choice, but also maximum predictability in cost." With practically no other DPC practices to serve as guides, Atlas MD built a busi- ness model from the ground up. Ten years later, the practice is thriving, with two offices and five physicians, each of whom treats hundreds of patients. Monthly mem- bership fees for adults range from $50 to DIRECT PRIMARY CARE (DPC) OFFERS PHYSICIANS AND PATIENTS AN ALTERNATIVE TO FEE‑FOR‑SERVICE CARE INVOLVING THIRD‑PART Y PAYERS. T WO PHYSICIANS WHO HAVE BEEN IMMERSED IN DPC FOR YEARS SAY IT HAS ALLOWED THEM TO GET BACK TO THE BASICS OF MEDICINE — AND THAT PATIENTS' RESPONSE PROVES IT IS A FORCE TO BE RECKONED WITH. 1 4