According to the National Institutes of Health1, the average primary care exam lasts 18 minutes. That's not much time for someone who has serious medical concerns or for someone who values a close connection with their doctor.
It can often feel like your doctor is quick to get out the door and on to see their next patient. Unfortunately, that's because they're often on tight schedules. A University of Chicago study2 found that most physicians don’t have enough time to fulfill all of their patient's needs. Survey results showed it would take more than 24 hours a day for doctors to follow national recommended guidelines for preventive care, chronic disease care, and acute care visits given their average number of patients.
Many people desire a more personal doctor-patient relationship. That's what makes practice models like direct primary care (DPC) and concierge medicine (CM) attractive. They each offer more personalized healthcare to patients who are willing to pay extra for it.
In this article, we'll take a closer look at what makes them different so you can better understand your options.
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Direct primary care (DPC)
Direct primary care (DPC) is a membership-based model where patients pay their physician directly through a monthly, quarterly, or annual fee rather than paying through an insurance provider. This fee covers primary care services, which can include clinical and laboratory services, consultative services, care coordination, and comprehensive care management.
But this fee doesn't cover all services. For that reason, some DCP practices suggest their patients use a high deductible health plan (HDHP) as well. That way, they'll have additional health coverage in case of an emergency.
The goal of this model is to give physicians consistent revenue without forcing them to spend time coding and billing like a primary care doctor would. The reduced administrative burden frees them up to spend more time with their patients.
In turn, patients experience longer visits with their primary care physician. A direct primary care model allows physicians to spend roughly 30 to 60 minutes per visit with each patient, according to Verywell Health3.
Patients also receive quick access to their doctor by phone, text, email, video chat, same-day or next-day appointments, and in some cases, even house calls.
Now, let's compare some of the pros and cons.
The pros of DPC:
- You can set up memberships monthly, and you can cancel your membership at any time.
- According to Verywell Health, memberships cost about $50 to $150 per month.
- The Affordable Care Act (ACA) considers DCP an acceptable non-insurance program.
The cons of DPC:
- Physicians don't accept insurance or participate in government programs.
- While a membership fee is often more affordable than traditional health insurance, some medical services aren't covered. This means patients could end up paying out-of-pocket if they go to a specialist, urgent care, or the hospital.
- If a patient has a DPC membership with an HDHP that comes with a health savings account (HSA), they can't make contributions to their HSA.
Who is DPC best for?
Given that DPC physicians don't accept insurance like Medicare or Medicaid, younger, middle-income patients typically benefit more from direct primary care than older or low-income patients. According to the Center for Optimizing Rural Health (CORH), DPC practices are also more than concierge medicine due to physician shortages and affordability. Therefore, rural areas significantly benefit from DPC physicians and practices.
Concierge medicine (CM)
Concierge medicine, concierge care, or boutique medicine, is another membership-based model that provides premium care to patients who can afford it.
Patients pay an annual fee to receive greater access, attention, and care from a concierge primary care doctor. With smaller patient lists and more time on their hands, these doctors can focus on building long-term, personal relationships with their patients.
Unlike DPC doctors, concierge physicians charge a patient's insurance company for their visit in addition to charging a membership fee. This allows concierge medical practices to have two forms of revenue while giving patients the help they need to pay for any services not covered by their membership fee.
Let's go over some of their pros and cons as well.
The pros of CM:
- Unlike DCP doctors, concierge doctors accept payment through their patient's insurance in addition to a membership fee.
- With CM, patients gain access to their doctor’s direct phone line. They can speak to their doctor at any time, either by phone or in person, through same-day appointments.
- If a patient has a major health problem, a concierge primary care doctor can coordinate specialist referrals or hospital care as needed.
The cons of CM:
- Concierge medical care requires an annual membership fee, paid in full or through monthly installments. The contract is for an entire year, and a patient can't cancel it midyear.
- It's more expensive than DPC. According to Forbes Health4, membership fees and monthly costs can range from $1,200 to $10,000 per year.
- Unlike DCP, concierge medicine is not considered an acceptable non-insurance option by the ACA.
Who is CM best for?
Concierge practices tend to cater to higher-income patients compared to DCP. People who need 24/access to a physician would get their money’s worth out of concierge care. This includes those who suffer from chronic conditions or older adults who make multiple doctor visits throughout the year.
How to get reimbursed for out-of-pocket medical expenses
Many of the health costs not covered by DPC or CM are reimbursable through an employer with a health reimbursement arrangement (HRA). An HRA allows employers to reimburse their employees tax-free for qualifying medical costs—so whether a patient uses DPC, CM, or traditional primary care, they can get their healthcare expenses covered.
Three of the most popular HRAs include:
- Qualified small employer HRA (QSEHRA): A QSEHRA is a cost-effective alternative to group health insurance. It's a health benefit tailored to small employers with fewer than 50 full-time equivalent (FTE) employees.
- Individual coverage HRA (ICHRA): An ICHRA is a flexible health benefit solution for organizations of all sizes.
- Group coverage HRA (GCHRA): A GCHRA, also known as an integrated HRA, is an excellent way to supplement a traditional group health insurance policy to help employees with their out-of-pocket expenses.
If your employer offers an HRA, they can reimburse you for more medical expenses than direct primary care or concierge medicine can cover.
Conclusion
Both direct primary care and concierge medicine offer patients peace of mind in knowing they can receive the personalized quality of care they want at any time. DPC tends to come at a lower cost, but those with serious health issues may prefer the 24/7 access that comes with the higher price tag of concierge medicine. An HRA can help to fill the gaps in coverage left by both of these options.
This blog article was originally published on February 24, 2021. It was last updated on June 20, 2023.
