DPC from 30,000 feet, on September 2020

  • Even with all the overhead reductions that come from not taking third party payment and/or from not billing on a fee for service basis
  • Even with those reductions transformed to increased primary care access that results in clear reductions on ED visits and other urgent care needs
  • Still, Direct Primary Care with panels of 600 patients per PCP, priced at $75/adult/$40/kid per month, does not financially outperform traditional, third-party paid, fee-for-service based primary care. (Search “Milliman” in this blog.) (Maybe 2-3%. Search “Anderson” in this blog.)
  • That $75/$40 is what it takes for a 600 patient panel to support a single PCP at average family physician compensation.

In other words, the DPC model has not miraculously enabled PCPs to “punch above weight” overall. Subscriptions for 38 minute visits, loosely scheduled to allow same day visits, and facilitate 24/7 access end up costing about as much as the existing FFS alternatives.

Perhaps, the whole DPC package makes the patient healthier in some way that does not show up as a financial savings. This is unproven. But DPC docs have not been content with one unproven overall claim. From its beginning, DPC has insisted on two unproven claims: better overall health and lower overall costs. The most clear recent emphasis has been on lower cost. The most clear recent evidence has been to the contrary.

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