Direct Primary Care vs. Concierge Medicine

Healthcare comes in many forms. One is the traditional medical model, where a physician sees a large number of patients in a day and then bills their insurance companies for their service. However, in recent years, two new models have become more popular: direct primary care (DPC) and concierge medicine. Both share some similarities, but their differences are major.

What is Direct Primary Care?

DPC is a model of primary care in which physicians charge patients a monthly or annual retainer fee in exchange for providing greatly enhanced access to and coordination of medical care. This model offers the same personalized healthcare, access to physicians, actionable advice and wellness training as concierge medicine, but at a fraction of the cost.

The key benefit of this model is the ability to access healthcare without insurance, which means they also aren’t subject to Medicare regulations. These practices don’t have to concern themselves with contracting and credentialing with insurance companies, which does mean they only have one source of revenue. Consequently, the practice must be diligent with its financial planning to ensure the patient fees are enough to support the practice operations. 

A significant difference between these two models is that DPC is explicitly mentioned in the Affordable Care Act as an acceptable option for receiving medical care without insurance, while concierge medicine is not.

What is Concierge Medicine?

Concierge medicine began as a movement in the mid-1990s as a way to offer high-net-worth individuals and their families enhanced access to high-quality primary care. These physicians see fewer patients than the traditional fee-for-service, like DPC, but the price is much higher overall.

Practices using this model profit from the monthly or annual fee as well as billing the insurance companies for each visit. Consequently, there are two sources of revenue; from the patient and from the billing insurance. Financially, concierge medical practices aren’t typically concerned with fighting insurance companies as they would within a traditional medical practice. However, if the practice accepts Medicare, then that practice is subject to government regulations for payment.

Similarities and Differences

Both types of practices claim to significantly reduce overhead by eliminating administrative resources associated with third-party billing, which results in lower price points for patients. After making the switch to one of these two models, physicians acknowledge several key improvements to their practice. 

  1. Increased availability and therefore, increased patient access
  2. More time for each patient encounter, which leads to improved quality
  3. Lower overhead costs
  4. Less stress

A good way to think about the difference between these two models is that concierge medicine was designed to serve the wealthy while DPC was designed to serve everyone, including employers. With that said, their fees will be vastly different, as well as what the membership fees cover. 

EBO MD is not insurance coverage. We encourage patients to maintain some level of health insurance to help cover the costs of medical care that they receive from medical providers/facilities outside of our practice. Insurance will help cover costs associated with, but not limited to, prescription medications, labs, imaging (X-rays, CT scans, MRIs, etc.), specialist consultations, hospitalizations, and surgeries. 

If you have questions about how your existing insurance policy will work with direct primary care, contact your insurance provider.

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