Bringing Competitive Direct Primary Care to Medicare
Direct primary care (DPC) is fast becoming an accepted alternative to fee-for-service payment in the private market, but it has yet to find its way into Medicare. That needs to change as soon as possible, and there is reason to hope that it will.
DPC is growing because many physicians and patients prefer it to the traditional, and still dominant, piecemeal payment systems run by most insurance plans, including Medicare. Instead of billing for each service they provide, DPC doctors get paid a fixed sum per patient, usually in the form of a monthly membership-like fee from the patient or the patient’s health plan (which is often sponsored by an employer).
DPC began as a way of providing premium services — “concierge care” — to patients who wanted expedited services and an extra level of attention from physicians. Concierge care is usually an add-on to the fee-for-service system. Concierge physicians bill insurance plans for the services they provide to their patients and also collect from their patients an additional annual or monthly membership fee. That additional payment entitles the patient to a higher level of service than other patients get, including more rapid scheduling of appointments.
Concierge care is a niche service. There are some consumers willing to pay an additional fee, on top of their regular cost-sharing requirements, to be able to get a higher level of service from their physician, but it is a small percentage of the overall market.
DPC has the potential to grow into something bigger and more transformative than concierge care by displacing, rather than supplementing, fee-for-service payments. Primary care physicians are supposed to help their patients stay healthy by making basic services and preventative care readily available to them. High-quality primary care can limit the need for expensive hospitalizations and medical interventions. Done right, primary care means careful monitoring of a patient’s health status and communicating with him or her as much as is necessary to avoid the progression of more serious health problems.