Differences Between Direct Primary Care & Concierge Practices

Our healthcare and business law firm works with many providers and medical practices to assist them in structuring medical practices that comply with state and federal laws, rules, and regulations.  Over the last few years, physicians and other healthcare providers desire to create non-traditional medical practices.  Traditional medical practices are those that accept commercial and government payors and bill insurance for medical care provided.  Although many traditional practices offer great medical care, there are systemic issues with these practices, including long wait times, low reimbursement rates, high deductibles causing patients to pay out of pocket, restricted face-time with providers, limited practitioner availability, etc.  Non-traditional medical practices aim to reduce some of these issues.  Two major non-traditional practices are direct primary care (or DPC) practices and concierge practices.  Although these terms are often used interchangeably, they stand for unique models.  This blog post discusses the differences between DPC and concierge practices.  If you need assistance structuring your medical practice or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Before identifying the major differences, it’s important to first understand these two models.

Direct Primary Care Practices: DPC practices are generally cash-only practices that offer medical care to patients without accepting insurance.  In DPC practices, patients pay a periodic fee to become a member of the practice and receive specific medical care and benefits.  The DPC practice may offer different tiers of membership based on what type of care the patient needs.  Care in excess or outside of the specific care included under a patient’s membership program is either offered on a fee-for-service basis or not offered at the practice.  Because the practice does not work with insurers and thus avoids the administration, overhead, and limitations that accompany working with payors, the practice can in theory provide improved and more patient-centered care.  DPC practices are typically governed by state insurance law.  If a state permits DPC practices, then the patient membership program and agreement must comply with the state’s DPC law(s).  Although DPC stands for direct primary care practices, many states expand the definition to include medical practices outside of those providing primary care.

Concierge Practices: Concierge practices are like traditional medical practices that accept insurance, but the practice offers a concierge membership program for a periodic fee to patients who wish to enroll.  Concierge programs offer members convenience and access to improve the patient experience.  Through the concierge fees, concierge medicine programs are able to limit the number of members accepted into the practice with attendant benefits that flow therefrom, such as prompt appointment scheduling, limited wait times, and 24/7 access to care delivered in a format convenient to members.  Importantly, the concierge fee is not health insurance, and no part of the fee goes towards member payments for covered services, including medical services, medications, or treatments.  Members, individually or through insurance, remain responsible for paying for all medical services, medications, diagnostic testing, treatments, specialist care, hospitalizations, or other services.

Now that we’ve explained the two models, the differences may be apparent.  Those differences are:

1. Direct primary care practices are cash-only and do not participate with or bill insurance companies; concierge practices participate with and bill insurance companies for the medical care provider.
2. The membership fee for DPC practices covers medical care and covered services; the membership fee for concierge practices goes towards non-covered services only.

This blog post discusses the differences between DPC and concierge practices.  If you need assistance structuring your medical practice or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

 

 

 

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