Direct Primary Care, More Affordable 'Concierge' Medicine, Is Hard To Scale Up : Shots - Health News : NPR

The model, which gives patients direct access to their doctors and longer appointment times, is proving hard to scale up.

Some people spend $200 a month on the golf course or on a fancy cable TV package, says David Westbrook, a hospital executive in Kansas City, Mo. His splurge? He pays Dr. John Dunlap $133 a month for what he considers exceptional primary care.

Dr. John Dunlap runs a direct primary care practice in Overland Park, Kan., offering patients direct access to him by phone and longer appointment times. The model is similar to concierge medicine.

"I have the resources to spend a little extra money on my health care to my primary care physician relationship," Westbrook says. "Because I have that access — and am very proactive in managing my personal health — I think I'm going to be healthier."

That $133 is in addition to Westbrook's monthly insurance premium, which he still needs to cover whatever Dunlap can't handle in his primary care practice, such as specialist visits, hospital care and more.

For that fee, he has access to "concierge medicine" perks: a long, thorough annual physical exam — lab work included, no waiting room time, same-day appointments. Any other visits during the year cost him $20. His doctor knows him and understands his medical history. If he needs an answer to a question, he can call his doctor's cellphone.

This model is for more affluent people, however, some people will take the extra expense to assure accessibility which has become a major issue for even the insured. Payment for DPC can be made monthly, annually or per visit.  Physicians benefit from less overhead, paperwork, billing, and collections.  Staffing can be greatly reduced not having to use billers, insurance claims, denials all of which increase overhead, time and expense.

For years, Dunlap took insurance and ran a traditional practice. Now he has about 800 patients who pay him monthly fees directly.

More than 1 in 5 wealthy people pay an extra fee for direct access to their doctor, according to a new poll from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. For low and middle-income people, the rates are less than half that.

David Westbrook, photographed in his home in Kansas City, Mo., is a patient of Dr. John Dunlap. He pays $133 per month and gets what he considers exceptional care.

Barrett Emke for NPR

"There are approximately 1,000 [direct primary care] practices in 48 states serving approximately 300,000 U.S. patients," says Sullivan from Harvard, citing the Direct Primary Care Coalition. There's less known about how many patients receive care in true "concierge" practices, Sullivan says. There are also many patients seen at hybrid practices, which charge an extra fee for some of the same perks these other models offer but also bill your insurance, like a traditional doctor's office.

There's a basic math problem here. If doctors see fewer patients, there would need to be many more primary care doctors practicing in this country for this model to be more widespread. And that's a tall order, says Sullivan.

"We have issues with access to primary care in this country. We don't have enough trainees or enough clinicians choosing primary care," she points out. "To have [providers] suddenly hopping over to this model would continue to probably decrease access for patients to primary care."

How fair or unfair do you think it is that people with higher incomes can get better health care than people with lower incomes?










Direct Primary Care, More Affordable 'Concierge' Medicine, Is Hard To Scale Up : Shots - Health News : NPR: