“Why should I join a Direct Primary Care (DPC) medical practice?”

Not everyone should. Yes, it’s true. DPC is not for everyone. If you can honestly say to yourself that you are happy with your primary care experience, as is, in the fee-for-service, insurance-driven model, then a DPC practice membership may not be advantageous for you.

However, we started Empower MD because many patients (and physicians) do not feel fulfilled or derive a meaningful experience from the current system. The following is just a small sample of the frustrations that I have heard from patients:

“It takes way too long to get an appointment with my provider.”

“My provider doesn’t have the time to address my concerns.”

“Most of my visit, the provider, is just looking at the computer.”

“It’s too hard to reach my provider directly with simple questions, concerns, or requests.”

“I want to know about more options for treatment, not just be offered medication.”

If these examples sound relatable, we invite you to read further. In order to explain how Empower MD chose the DPC model, let’s examine the status quo.

In primary care offices today, reimbursement is based on fee for service or some similar derivation of the model. In this model, physicians typically rely on reimbursement from insurance payers for services rendered. To pay the bills and keep the doors open, a physician practice will need to see more patients, which translates to higher “relative value unit,” or RVU, generation. The more patients that a physician sees, the more RVU’s are generated, and the higher the income of the practice will be. Sounds like a fair deal on the surface, but we now are experiencing the consequences of the model and the incentives that it creates. For instance, because physicians rely on insurance reimbursement, they are somewhat at the mercy of what the insurance providers are willing to reimburse. This can change over time, and it is very common for physicians to be reimbursed at lower rates for the same services over time (example: lowering rates of Medicare or Medicaid reimbursement for physician services). This, in turn, leads to pressure to see even more patients to make up for the lower reimbursement per patient. More patients per day to generate the same RVU means less time per patient. Sound like a familiar experience?

In this system, it may seem to the patient like the physician is the problem; the physician is in a hurry, doesn’t have time to listen, and doesn’t care to educate the patient or walk them through treatment options. It may seem that the physician doesn’t have time to respond to follow-up concerns, take the time to focus on lifestyle modifications, or sometimes even address the primary concern that the patient had (example: instead of creating an evaluation and management plan, just referring to the specialists for your plantar fasciitis, migraine headaches, and chronic allergy concerns). The primary issue is that the system in which primary care operates has lost its way. It is no longer primary. In many systems, a primary care visit is shorter in duration than a specialist visit. No wonder a patient is left with more questions than answers when their “annual visit” with their primary care physician lasted twelve minutes and mostly consisted of discussions about referrals and medication adjustments.

In reality, primary care physicians are some of the smartest people I know. They care deeply about their patients. They desire to form relationships and get to know how their patients’ social, financial, family, and occupational dynamics play a role in their health. They care about prevention and population health. They would rather spend more time getting to know their patients and have more availability and access for follow up and treatment planning. Most would prefer to take ownership of most of the patients’ healthcare needs. However, the current system largely prevents primary care physicians from doing most of this to their best ability.

While much more could be said about the shortcomings of the current healthcare system for delivering primary care services, I think you get the idea. And, if you are reading this, chances are you have also had your fair share of frustrations with primary care. Put simply, the current fee-for-service system of primary care with fifteen to twenty minute office visits, limited follow up availability, and metrics for insurance reimbursement are benefitting insurance companies but are not serving patients or physicians. This is the root of the issue that we face and also the status quo for primary care today.

Direct Primary Care is currently the best solution to these problems. Firstly, the model eliminates the middleman. The physician no longer spends precious time during your visit checking boxes for insurance documentation that may not even matter to you. This also frees the physician to formulate a plan based on your preferences without having to consider if insurance will reimburse for the treatment plan agreed upon. In the DPC model, physician panels are typically 300-600 patients, depending on the practice. Compare this to 2,000-2,500 in typical models. This allows for increased access to your physician, same day or next day appointments, and more time during each visit. The patient experience is better, the value of the care is higher, and ultimately the cost savings for the patient and healthcare system provide enormous net financial benefit. DPC models negotiate cash-based pricing on labs, imaging, and medications. Many times these prices are better than the same services in the traditional healthcare system. DPC physicians can see you for urgent concerns, sometimes preventing trips to urgent care or the emergency department. Again, saving the patient time and money. Did I mention there are no co-pays?

In my opinion, one of the most important aspects of the direct primary care model in increasing value, reducing cost, and enhancing the experience of the patient is the following: giving sufficient time for the provider-patient relationship to form allows your physician to develop understanding the root causes of the health concerns that you have. When you have a primary care physician that has the time to inquire about your medical history, lifestyle habits, occupation, family, and interests, you receive better care. Instead of seeing three specialists for seemingly different conditions, the primary care physician has the bandwidth to put the pieces of the puzzle together, potentially finding underlying themes to dysfunction and working with the patient to restore function. The DPC model allows you to get the most out of your primary care provider’s training, knowledge and experience.

From the provider perspective, the DPC model also restores the essence of why providers chose primary care in the first place. For me, I chose to pursue family medicine because I cherished the relationships that I built with patients. The continuity of care is something that I have always loved about this specialty. DPC enhances both relationships and continuity of care. DPC reduces burnout. Providers have more autonomy and time to do what they believe is best for the patient. Primary care providers want to investigate, get to the root cause, think holistically, and genuinely help their patients not only with treating disease but creating optimal health. The DPC model gives providers the framework by which they can accomplish all of this.

In summary, Direct Primary Care is a model of primary care delivery that focuses on increased physician availability, transparent costs of services, increased time during office visits, and the chance to genuinely connect with a primary care provider in a way that works for you. It truly is a win-win for the patient and provider.