Similarities
Direct primary care is a term often associated to it’s healthcare companion, ‘concierge medicine.’ The two terms belong to the same family of healthcare; however, concierge medicine encompasses many different healthcare models, direct primary care being one of them.
Concierge medicine and direct primary care both avoid insurance to prevent the charges associated with administrative overhead. There are no insurance co-pays, no deductibles, and no co-insurance fees.
Both practices claim to significantly reduce overhead by eliminating administrative staff resources associated with third-party billing, which results in lower price points for patients. After switching to direct primary care and concierge medical model, physicians acknowledge three key improvements to their practice.
- The first is increased availability and therefore, increased patient access.
- The second is more time for each patient encounter, which leads to improved quality.
- The third, as previously mentioned, is lower overhead costs.
Rather than going through insurance, direct primary care and concierge medical practices go for a more direct financial relationship with patients while offering patients comprehensive care, preventative care, longer appointment times, same day appointment scheduling and immediate access to the physician all for an affordable fee.
Concierge Medicine
Even though concierge medicine can be vague term, the traditional form is where the patient pays a monthly or annual fee that gives them direct access to a physician. Concierge medical practices profit from this monthly/annual fee along with bill insurance companies for visits. Consequently, there are two sources of revenue; from the patient and from billing insurance.
Financially, concierge medical practices may not be as concerned with fighting insurance companies as they would within a traditional medical practice.
An important drawback is that if the practice accepts Medicare, then the practice is subject to government regulations for payment.
Direct Primary Care
The direct primary care model differs from concierge model by completely avoiding insurance. A key benefit from not taking insurance is that the practice is not subject to Medicare regulations. Direct primary care practices also do not have to concern themselves with contracting and credentialing with insurance companies. Rather they rely solely on the monthly/annual fee from patients.
The important drawback; however, is that there is only one source of revenue: from the patient. Consequently, the practice must be diligent with its financial planning to ensure the patient fees are enough to support the practice operations.
Direct primary care is explicitly mentioned in the Affordable Care Act as an acceptable option for receiving medical care without insurance, while concierge medicine is not.