Although news stories appear almost daily about physicians making the switch to direct or concierge care practice, most of these nontraditional practices are young and small, without a lot of data to back up their anecdotal benefits.
Recent research from the Robert Graham Center offers clearer insights into this emerging model. Highlights from the report, published in the Journal of the American Board of Family Medicine, include the following:
- Nearly all (93 percent) respondents that met researchers' definition of direct primary care (DPC) worked in practices with four or fewer clinicians, suggesting that the nimbleness of small practice makes the DPC model easier to adopt, according to study authors Philip Eskew, D.O., a Robert Graham Center visiting scholar, and Kathleen Klink, M.D., former medical director at the Robert Graham Center.
- Of the 116 practices that provided adequate cost information, the average monthly cost to the patient was $93.26; the median cost was $75, with a range of $26.67 to $562.50 per month. Practices that identified themselves as "concierge" charged more than those referring to themselves as "direct primary care."
- Although widespread data on DPC costs and outcomes does not yet exist, the researchers cited unpublished internal studies completed by two DPC companies, Qliance and Access Healthcare. According to its own research, Access Healthcare reported its patients spent 85 percent less out-of-pocket for their total cost of care when compared to the same level and amount of care in traditional settings.
- The majority of the 141 DPC practices studied (84 percent) relied only on the monthly fee without any third-party fee-for-service payments, while 65 percent opted out of Medicare.
- Although researchers expected to see higher patient fees among "split" or "hybrid" practices that still accepted some insurance than in lower-overhead "pure" DPC practices, their research revealed no significant difference in periodic fees between the two groups.
Nonetheless, the central question that has yet to be answered is whether DPC improves care.
"The logical inference is one that primary care advocates have insisted is true in every health system--as utilization of low-cost comprehensive primary care increases, the need for high-cost emergency and specialty services declines," Eskew and Klink wrote. "Proponents of DPC practices refer to these benefits regularly, but if the model is to be more widely adopted, more data is needed about DPC practices to document potential improvement."
To learn more:
- see the announcement
- read the study