The creator of the nation’s first direct primary care (DPC) family practice shared how and why it works during his Tuesday afternoon session: Introduction to Direct Primary Care: A Model to Help Independent Practices Thrive While Meeting the Quadruple Aim.
Brian Forrest, MD, described himself to his FMX audience as a “recovering insurance-aholic” who served as the prime mover behind “Direct Pay” or “Membership Medicine.” Fifteen years later, his thriving practice, Access Healthcare in Wake County, N.C., still hasn’t filed a single insurance claim.
In addition to caring for patients, Forrest also consults with, and champions the cause at the local, state, and national level for, family physicians and other doctors transitioning to DPC. He sees the model as a mechanism that enables practices to remain independent, as well as fight physician burnout, by putting the focus back on the patient, rather than checking off a long series of boxes on a computer screen.
“I use an EMR,” Forrest said. “I love my EMR, but my computer never goes into the exam room.”
One big benefit DPC offers is eliminating the overhead cost generated by insurance-related staffing requirements that necessitate an average of four full-time equivalent positions per physician.
Forrest said a fitness center illustrates how using DPC can simplify operations and maximize assets. A gym, he said, like a DPC, charges a monthly fee for use. If a gym used the current health care model, people would pay based on each weight lifted, and somebody would have to follow each person around keeping track.
“How much would the gym have to pay somebody to do that?” he asked.
Reducing overhead lowers out-of-pocket costs, improves health care access for the uninsured and poor, and leads to better price transparency.
Lower overhead also means practices can shrink the size of their patient panel. Instead of 4,000 or 5,000 patients, physicians in a thriving DPC can see a panel as small as 800-1,200 patients. Forrest said that even as few as 250 or 300 patients generate enough revenue for a practice to survive. And, he said, fewer patients means longer visits and improved care.
The main roadblocks Forrest said he sees are the difficulties in making a far-reaching, disruptive transition and recruiting a patient panel in a world conditioned to insurance co-pays.
DPC has become a hot topic. More medical students report seeing DPC as a means to achieving a successful career in family medicine, while companies are indicating that DPC looks to be a viable option in reducing their health care costs for employees. Also, work continues to make DPC one of the alternative payment models under the forthcoming Medicare Access and CHIP Reauthorization Act (MACRA).
Forrest said family physicians should take note that CMS recently awarded a $15.8 million Transforming Clinical Practice Initiative grant to the Consortium for Southeastern Hypertension Control to help practices achieve quality improvements using the DPC model. The grant will give 600 DPC practices free analytic software to compare performance outcomes between DPCs and about 2,800 non-DPC practices.
Those participating in this DPC IMPACT project must commit to moving to the DPC model within the next six months or have started a DPC within the past year. For more information, go to dpcmh.org or email firstname.lastname@example.org.
The AAFP’s DPC Member Interest Group will meet from 9:30-11:30 a.m. on Saturday in room W303C. The discussion, Forrest said, will focus on advocacy issues concerning DPC.