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Quality or Quantity?

DPC and Concierge Practice

Attorney Ezra ReinsteinWhen you signed up to be a physician, you probably didn’t expect to rush from patient to patient, giving each a hurried 10 minutes before sending them on their way and turning to a mountain of paperwork.

Unfortunately, many doctors have to run their practice like an assembly line, maximizing the number of appointments packed into a day in order to compensate for smaller per-patient revenues.

There are alternatives that might be right for you: the Direct Primary Care (aka “DPC” or “Direct Pay”) model, and the concierge model.

A physician in a traditional practice may see more than 2,000 patients a year; a doctor in a concierge or DPC practice will often have fewer than 500 patients.

A smaller patient panel allows you to spend more time with each individual and give them a higher level of service. The specifics vary from practice to practice, but many offer longer appointments that allow for in-depth discussions about wellness and prevention; little or no waiting; house calls; increased access to the physician by cellphone and email; and/or spa perks, like bathrobes instead of johnnies.

In exchange for these benefits, patients pay a monthly or annual retainer that guarantees them reliable access to top-notch, unhurried, individualized medical care. In some cases, the retainer covers all in-office care; in others, patients pay the annual fee and are billed for each office visit. It’s also possible to set up a hybrid practice — one in which you set aside a few hours a week for those patients who pay an extra fee for extra services.

A lady accepting calling card from an insurance offer.

What does a DPC practice give you? A steady and reliable revenue stream. A chance to spend more time with each patient, listening to their concerns, and developing personalized care plans that meet their individual needs. A reduced patient panel that maintains (or increases) your total revenue and reduces the likelihood of burning out.

Of course, there are trade-offs. You have to opt-out of Medicare and Medicaid, and generally cannot accept insurance. This can be a serious obstacle for patients, despite the heightened level of service and personal connection to you they would gain. But it can be very attractive to patients who can afford it, or whose insurance policies have large deductibles. Rather than paying a several-thousand-dollar-deductible every year out of pocket for impersonal, institutional medicine, they can spend their money on an all-inclusive DPC practice. It’s also an option for patients who have health savings accounts.

Because DPC and concierge practices do not cover emergency room care, hospitalization, major surgery, high-tech diagnostic tests like CT scans, or specialists who aren’t part of the boutique practice, patients should still have health insurance, the AARP advises. In fact, it will be important that your patients acknowledge this and agree to maintain independent insurance, at least for catastrophes.

Think about it. Weigh the pros and cons. If it seems like an avenue worth pursuing, get in touch with me, and I’ll guide you through the process.


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