DPC as a Viable Business Model for Practicing Primary Care

DPC as a Viable Business Model for Practicing Primary Care

Dr. Gruender is a board certified Family phone, and videoconferencing visits in addition to Medicine physician who owns Liberty providing traditional office visits. Physicians typically Family Medicine, a Direct Primary Care clinic carry somewhere between 600 and 800 patients on located in Columbia, Missouri. She opened their panel which is a stark contrast to the traditional her DPC clinic over 4 years ago and it was the first model of practicing medicine where physicians have of its kind in the mid-Missouri area. She truly enjoys 2,500 to 3,000 patients on their panel; this allows offering amazing, relationship-based care while physicians to spend more time with each individual supporting her community in the process. patient when care is needed.

GIVE US A BRIEF OVERVIEW OF DPC FOR THOSE WHO ARE NOT FAMILIAR WITH IT.

DPC, short for direct primary care, is a model of practicing medicine where the patient pays an affordable membership fee in exchange for primary care services. Typically, thisisdone withoutinsurance although patients can still have insurance they use outside of the clinic (and in some DPC clinics, even inside the clinic for certain services). Most DPC clinics offer laboratory services, prescription dispensing services, procedures at minimal or no additional cost, and comprehensive primary care including care coordination with specialists or other facilities. With their membership, patients do not pay a co-pay for services and have unlimited visits available with their physician; most clinics can provide care through multiple forms of telemedicine including text, email,

WHAT ABOUT THE SERVICES NOT COVERED IN THE DPC CLINIC?

DPC can provide about 90% of the healthcare services most patients need including general primary care, procedures, laboratory services, and medications. However, for the larger medical needs like hospitalizations, surgeries, specialist visits, and imaging, additional coverage can be financially helpful. It is recommended that anyone who is a member of a DPC clinic that does not already have additional insurance coverage should obtain some form of additional coverage for unforeseeable expenses or services that are not provided in the clinic. Most clinics will recommend patients consider catastrophic plans with high deductibles or health sharing plans, which work well with the DPC model of primary care. Bridget NT Gruender, MD, MS

IF PATIENTS HAVE INSURANCE, WHY WOULD THEY SIGN UP FOR A MEMBERSHIP PRACTICE?

DPC clinics are quite different in how they are set up from the traditional model ofprimary care and this is beneficial for both the patients and the physicians. Traditionally, family physicians will see anywhere between 20 or 30 patients per day in the clinic whereas in the DPC model, they will typically see 6 to 10 patients per day in the traditional office setting with additional care provided as needed via nontraditional methods for concerns not requiring hands-on care. This approach to care allows much more time per patient in the clinic and the ability for the patient and physician to communicate in nontraditional methods including text, email, phone and videoconferencing when appropriate. Even patients with insurance can appreciate the convenience and personalized care that is easyto attain in a DPC practice given the smallerpatient panels and thus more time spent with each patient when a need arises; some insured patients will even find that they save quite a bit of money on prescription medications and laboratory services through their DPC membership as opposed to using their insurance.

ARE PHYSICIANS TYPICALLY TAUGHT ABOUT RUNNING BUSINESSES WHILE IN MEDICAL SCHOOL IN RESIDENCY?

Unfortunately, most physicians will receive little to no training in running a business as the majority of physicians will end up joining a larger system as an employee. For those physicians who are interested in independent practice as a DPCphysician, there are manyveteranphysicianswhoareavailabletoofferadvicepersonally, at conferences, as well as through online groups. There have also

been a few books written on the topic that are helpful resources including The Official Guide to Starting Your Own Direct Primary Care Practice by Doug Farrago. The local Chamber of Commerce is usuallya good place to start to connect with otherbusiness owners as well as to integrate into the business community.

IN STARTING A DPC PRACTICE, HOW ARE THINGS FUNDED?

Starting a DPC practice is different than starting a regular business in that you can start quite affordably with minimal overhead and this is typically the suggested format. Most practices will start with just the physician, minimal office space (some even use their homes), and minimal equipment as a micro practice. As the patient panel grows, the physician will add additional staff, supplies, and space as needed. This way of starting a DPC practice allows physicians to open without taking out large loans and in some cases, no loans at all. This does not however, mean that DPC practices are without financial risks or hardships. Most physicians will end up moonlightingto coverexpenses in the beginningas they typically will not pay themselves a salary (or only a very small one) while their panel is growing to keep overhead low.

IF YOU START WITH NO STAFF, HOW EXACTLY DOES THAT WORK AND WHEN IS A GOOD TIME TO ADD THEM?

Starting a business with you as the sole employee can seem scary, but as a physician, you have all of the skills necessary to successfully do so, especially ifyou are committed to the outcome. Practices who start with no additional employees will typically add

them when the panel reaches between 100 and 200 patients, as most physicians find that this is the time when they are unable to do everything completely by themselves. That being said, some practices will start with one additional part-time employee and other practices will wait longer to add an additional employee; this is solely based on the physician’s preference and financial situation in most cases.

ARE YOU OPEN MONDAY THROUGH FRIDAY, OR HOW DO YOU OPERATE?

MostDPCclinicsaresimilarin theirbasestructureoffunctioning; however, details like business hours can vary greatly depending on the physician. Some practices will function Monday through Friday during the daytime hours while others will offer some evening hours and even some weekends. Clinics that are just starting may offer only 2 or 3 days per week or possibly partial days while they are growing their panel and moonlighting at other locations. One of the great benefits of DPC clinics is amazing care can still occur even when the clinic is not open or the physician is not in office as the patientis able to reach the physician via nontraditional forms of communication like text and email. Most DPC physicians will offer their patients access after-hours for urgent matters. This means the physician is almost always on call; however, most physicians find that patients respect their time and do not contact them after hours unless absolutely needed.

AS AN INDEPENDENT PRACTICE, HOW DO YOU GET NEW PATIENTS?

In a traditional medical practice, patients are funneled to the clinics by the hospitals and other healthcare systems meaning there is usually never a shortage of patients. In a DPC practice however, patients must fully understand the benefits of the membership model in ordertotake the leap from the traditional wayofreceiving care to the DPC model of care. Unfortunately, because most people are accustomed to the traditional model ofreceiving medical care, when a practice opens in a community without a prior DPC clinic in the area, there is a large amount ofeducation that needs to happen with the general public because they are uncertain of what DPC actually entails. When many people learn about DPC, they think the model is too good to be true and may doubt that physicians are able to deliver everything they promise. However, once patients sign up for a membership and try it for themselves, they absolutely love it. This lackofeducation aboutDPCcan lead to slowerinitial growth for practices that are opening in an area without a current DPC clinic.

WHAT ARE SOME OF THE BENEFITS FOR PATIENTS AND PHYSICIANS IN THE DPC MODEL OF CARE?

Almost everything about DPC is positive for both the physicians and the patients. Physicians are able to spend more time with each patient and offerverypersonalized care that is not rushed. Patients areabletocontacttheirphysicianconvenientlyviamultipleavenues and most patients will save money on medications, laboratory services, and procedures through the DPC model of care. DPC physicians always search for the most affordable avenues to offer amazing care for their patients, which is a huge benefit for both the patient and the overall healthcare system as the DPC model of primary care decrease the overall cost of healthcare.

WHAT ARE SOME OF THE NEGATIVES IN THE DPC MODEL OF CARE?

Although there are not many negatives in DPC, one would be that this affordable and accessible option for primary care does attract some patients who have not received primary care in many years or maybe their entire adult life so the first time you see them you are correcting many issues at one time. The benefit of this however is that DPC can help them continually work on improving their health given the affordable and accessible access to not only primary care but also medications. Another negative would be that as an independent small business, you must attract potential patients, which leads to the need for marketing and networking as well as having a presence on social media as a business. If you are the first DPCpractice in yourarea, you will also need to educate the community about the benefits of DPC as they very likely will only know about the traditional model ofmedicine utilizing insurance.

HOW CAN INTERESTED PHYSICIANS LEARN MORE ABOUT THE DPC MODEL OF PRACTICING MEDICINE?

Each year, therearemultipleconferencescentered around theDPC model ofcare where both veteran DPC physicians along with those interested in DPC or just opening a practice can come together to expand and share their knowledge. The DPC community of physiciansisoneofthemostacceptingandopencommunitieswhere physicians who are juststartingoutorconsideringtakingthe leap into DPCcan reach outtoveteran DPCphysiciansforadviceon howtostart and how to be successful; as this model ofcare is quite different from the traditional model, these communities are also where many DPC physicians go for support on other issues throughout their DPC career including growing their practice, dealing with business issues, and advice on medical concerns including diagnosis and treatment.

ANY CLOSING REMARKS?

Commitment to the end goal when starting a DPC practice is essential as it is a process and does take a substantial amount of time and effort to fully establish your practice and be financially successful. Many DPC physicians will agree that the DPC model of primary care has allowed them to fully express how passionate they are about caring for patients and their community and they are grateful that they are able to offer these services to them.