What makes a direct primary care practice successful?


“When starting out in this practice, you really have to have built a reputation in town,” said Dr. Hsieh. “In this city, we’ve already had people try direct primary care who have failed because they came out of residency or people didn’t know who they were. You really have to have had a reputation of quality and service and patients should know about you.”

In many cases, physicians can bring their patients with them into direct primary care practice; however, some may not be able to based on their prior employment contract. Dr. Hsieh, for example, could not speak about his new practice or market the business until the day after he left his former practice, he said.

Dr. Lamberts said about 200 of his former patients initially followed him to direct primary care and another 100 have joined since. Before departing his former office, he gave a presentation to his patients about the direct primary care model and what the structure entailed.

Making patients aware of direct primary care and how it works is a top challenge to the model, Dr. Ellzy of the AAFP said. Some patients incorrectly believe that DPC covers all health services including hospitalizations and surgeries. Many DPC patients still carry insurance for hospitalizations as well as specialist visits.

“Part of it is understanding what direct primary care is and isn’t as you move from an insurance basis,” Dr. Ellzy said. “A lot of it is patient education, That’s one of the biggest issues.”

Strong team, alternate mindset

Putting in place an efficient, dedicated staff is also key to establishing a fruitful DPC practice, Dr. Hsieh noted. He credits his practice director, Jami Feitz, with keeping things running smoothly through patient education and advocacy. Ms. Feitz aids patients in navigating specialist visits, medication access issues, and payment.

“You can have the best business plan, you can have the best economics, you can even have the best reputation in town, but if you don’t have someone to run the logistics of your practice, you’re sunk,” Dr. Hsieh said. “As soon as you walk out of the exam room, that patient is going into that fragmented, complicated health care system. They need someone experienced with the special skills to help them through that process”

Dr. Lamberts adds that of all the shifts necessary for a prosperous direct primary care practice, a different mindset is among the most important for physicians.

“It’s a big change in philosophy,” he said. “You suddenly are focused on keeping patients away from the office rather than having a full office. You’re focused on keeping people well, rather than benefiting from people getting sick. That’s a challenge to lose the mindset and to suddenly celebrate if you have a day that’s not very busy or your office is empty. That’s a good thing.”

Direct primary care by the numbers

A 2018 survey by AAFP of 148 direct primary care physicians reveals how doctors are structuring their practices.

  • 80% charge a fee to patients and do not bill any third-party payer.
  • 14% engage with one or more third-party payers.
  • 54% are male.
  • 56% are greater than 15 years post residency.
  • 20% are less than 7 years post residency.
  • 72% of practices have been in operation less than 3 years.
  • 11% of practices have been in operation less than 1 year.
  • 54% of practices started from scratch.
  • 34% of practices were converted from an existing practice.
  • 57% of practices have employer-based contracts.
  • 29% of practices are interested in employer-based contracts.
  • 58% of practices supplement their income through other practice opportunities.
  • 345 patients is the average panel size.
  • 596 is the average target panel size.
  • 91% of physicians would promote the model to others.

SOURCE: The American Academy of Family Physicians


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