DPC or Direct Primary care is a new name for an old idea: it is a model of medical care where providers do not take payment from insurance companies. This means that DPC physicians work directly for you.
Primary care is medical care that takes care of all the day-to-day issues. This includes wellness visits and checkups (including labs and pap smears); management of chronic conditions (high blood pressure, diabetes, thyroid disease, arthritis, depression, and many others); treatment of minor injuries like sprains; IV fluid replacement for dehydration or headaches; stitching of minor wounds; and minor procedures like skin biopsies and wound care.
Specialty care on the other hand refers to specialized procedures like surgery or care for more complex health care problems like severe heart or lung disease, rheumatological diseases, etc.
Your bank account or credit card will automatically be billed for your membership each month. No surprise bills or unexpected costs.
When it comes to primary care (see above if you are not sure what primary care is), health insurance rarely benefits patients. Involving an insurance company increases costs to patients and providers, burdens your doctor with red tape and paperwork, and distracts providers from their most important duty--taking care of patients. This higher cost, in turn, drives the need for physicians to see more and more patients. A typical family medicine provider in the US sees 15-25 patients per day; a DPC physician on the other hand, sees 6-10 patients a day. This means that Dr. Coleman has more time to spend with you.
Health insurance should be like car insurance: You have car insurance for unexpected major expenses like a car accident. but you wouldn’t use your insurance for the day-to-day maintenance on your car like changing the oil or replacing tires. But recently, we have been relying on health insurance to pay for more and more of our basic needs, which increases costs.
The Direct Primary Care movement is advocating for a return to traditional primary care, where costs are kept low by limiting extra staff and billing requirements while allowing your physician to provide more personalized, thorough care for their patients.
Some would argue that everyone can benefit from a DPC membership. For those who don’t go to the doctor regularly, you may be missing early signs of disease like high blood pressure, heart disease, or diabetes. A regular check up every year can catch these early, and a relationship with a doctor who has the time to spend with you can help you learn how to stop these conditions early on or treat them effectively with healthy lifestyle changes and medications before you develop more serious complications.
Unexpected injuries or illness can happen to anyone, anytime. If you don’t have a primary care provider, then your treatment options are usually limited to an Urgent Care or Emergency Room, which means long wait times and expensive medical bills. If you have a typical primary care provider, then you may have to wait weeks for an appointment, or you may see another provider who may not be familiar with your specific medical history. With a DPC membership, however, when unexpected events occur you get to see your doctor. Every time.
Call Dr. Coleman, anytime. As a matter of fact, that’s the point of a DPC membership--being able to reach your doctor whenever a concern comes up. Often people assume that if they have a problem after hours then they need to go to the ER or an Urgent Care, but often your primary care provider can take care of these issues. A quick call with Dr. Coleman can determine if you need emergency care, or what other options there may be. The solution may be a next day appointment , an after hours clinic visit or even a house call.
When medical providers work with insurance companies, there are added expenses for the clinics, labs and hospitals. Insurance companies have complicated billing requirements, often deny claims, and may not pay providers promptly. All of this results in additional staff, time, and expense on the part of the clinic, labs, and hospitals.
On the other hand, when a lab or hospital knows they will be paid promptly, by DPC providers like Dr. Coleman, the billing process is less expensive, and they often offer their services for a discounted price. With DPC, the cost of any tests is transparent before you have the test done, so there are no surprise bills later.
Absolutely. Insurance is still important for major or unplanned medical expenses, such as surgery or hospitalization. Also, visits with specialists and some medications may be less expensive if they are covered by your insurance. But when your primary care needs are met with your DPC membership, then your insurance can truly be used for major medical expenses.
Your insurance coverage for imaging, labs, and other tests does not change. The fact that Dr. Coleman has ordered the test will not affect your coverage for these tests should you choose to utilize insurance.
This does not work well. The benefit of having a DPC provider is that you have a doctor who knows you and your medical history, and has your records, including your medications, previous surgeries, allergies, etc. By establishing this relationship, your doctor can be ready to care for you immediately when the need arises. Although we provide excellent care for urgent issues, that care is based on the strong foundation of an already-established doctor-patient relationship. Also, enrollment in a DPC membership involves completing a Patient Agreement with your physician, a process which takes time to review the policies, benefits, and expectations. It would not be ethical to ask a patient to sign such an agreement in the setting of an urgent medical situation, without reviewing the agreement fully and answering all of your questions. If you think a DPC practice is a good fit for you, it is best to sign up now, so that Dr. Coleman is ready when you need her.
As a Family Medicine doctor, Dr. Coleman is happy to care for your whole family, even those who are just visiting. She will take care of their acute illness/injury for a one-time charge. In this case, they do not need to sign up for a long-term membership. On the other hand, if you have family who lives in the area for part of the year (for example, our many “snowbirds”) then feel free to refer them to Dr. Coleman as DPC members. That way they get all the benefits of a DPC membership, and Dr. Coleman can coordinate with their medical providers in their other home states.
As of this moment, no. However, there is currently (as of June 2020) a proposed regulatory action being considered by the President’s Administration that would define DPC as qualified medical expenses for HRAs and HSAs, NOT insurance. Here is the link with the most current communication on the proposal: https://www.federalregister.gov/documents/2020/06/10/2020-12213/certain-medical-care-arrangements
If you are still uncertain, Dr. Coleman would be happy to sit down and answer any questions you have in person at no charge. This gives you the chance to ask any questions and see if this is the right practice for you, without any financial obligation. Just call or e-mail to schedule a “meet-and-greet” visit.