DPC

[NontradCA]

Hello all. I'm a 2nd year medical student who has some questions concerning DPC:

First and foremost, I think it's a great thing for physicians to be trying to get insurance companies out of the loop,if that is the intention. My concern is access to care. From my understanding only middle class to rich folks would be able to afford this. What about Medicare and Medicaid patients who cannot afford a subscription based service?

Additionally, could you have more patients on the panel that Atlas suggests? Could you also not charge more than he suggests? Or less? Or different prices for patients based on their income level?

Can you still bill Medicare for the service and refund that portion to the patient?

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[bronx43]

Hello all. I'm a 2nd year medical student who has some questions concerning DPC:

First and foremost, I think it's a great thing for physicians to be trying to get insurance companies out of the loop,if that is the intention. My concern is access to care. From my understanding only middle class to rich folks would be able to afford this. What about Medicare and Medicaid patients who cannot afford a subscription based service?

Additionally, could you have more patients on the panel that Atlas suggests? Could you also not charge more than he suggests? Or less? Or different prices for patients based on their income level?

Can you still bill Medicare for the service and refund that portion to the patient?

Lol. You need to quit medicine and just go be a saint somewhere. I have never encountered the idea of reverse balanced billing...
But then again, you're a MS2. Keep up with the idealism.

 

[VA Hopeful Dr]

Hello all. I'm a 2nd year medical student who has some questions concerning DPC:

First and foremost, I think it's a great thing for physicians to be trying to get insurance companies out of the loop,if that is the intention. My concern is access to care. From my understanding only middle class to rich folks would be able to afford this. What about Medicare and Medicaid patients who cannot afford a subscription based service?

Additionally, could you have more patients on the panel that Atlas suggests? Could you also not charge more than he suggests? Or less? Or different prices for patients based on their income level?

Can you still bill Medicare for the service and refund that portion to the patient?

1) You'd be surprised what people can afford. Most of us are only charging around $50/month. Plus, I have several patients who save more than the cost of membership on drugs alone.

2) You can do more, but you run the risk of getting too busy and losing same-day appointments or getting overwhelmed with after-hours care. Now going from 600 patients to 700 likely wouldn't do that, but getting closer to 1000 probably would. You also could charge more (many places do), but I like the idea of charging the smallest amount I can that still affords me a decent salary. Plus, $50/month is easy to remember and do that math with. In fact, let's run the numbers real quick. 600 patients x $50/month x 12 months equals $360,000/year. My overhead, which is higher than most because of expensive rent, is right at $120,000/year. That still leaves me with $240,000 which is significantly above average for family physicians. Adding a single partner, since 90% of that overhead wouldn't change with 1 additional physician, would put me closer to $280,000, maybe even up to $300,000. You certainly could charge based on income, but people don't like sharing that information. You also could tick people off if they know they could be paying less.

3) As of now, you cannot bill medicare for DPC services. If you go full-concierge, like MDVIP, you can but then you're working with insurance and that defeats the purpose.

 

[dorothyntoto]

Direct primary care is great for some people, especially those who have really high deductible plans, or basically catastrophic insurance. If they can get all their, or their kid's, primary care needs met with ~50-100/mo that is a lot more affordable than 400-500/mo per person for a better insurance plan. It's especially useful if the clinic can run some of their own labs... DPC isn't out of reach for a lot of people, except in the geographic sense...

 

[shaggybill]

So how does this work? Do patients keep very basic/cheap health insurance for catastrophic events, and then pay the $50-100/month for DPC services?

 

[deleted480308]

So how does this work? Do patients keep very basic/cheap health insurance for catastrophic events, and then pay the $50-100/month for DPC services?

yes

 

[deleted480308]

OP...it is illegal to not charge medicare/medicaid patients their full copay when providing services to them and billing medicare/aid.......ironic because the point is they are so broke they need help, but the government wants the trip to cost the patient something to help cut down on useage

 

[DoctwoB]

OP...it is illegal to not charge medicare/medicaid patients their full copay when providing services to them and billing medicare/aid.......ironic because the point is they are so broke they need help, but the government wants the trip to cost the patient something to help cut down on useage

Is this true? Because if so, how are drug company copay-rebate programs legal?

 

[VA Hopeful Dr]

Is this true? Because if so, how are drug company copay-rebate programs legal?

Read the coupons, they almost always have exclusions for medicare/medicaid/tricare.

 

[septoplasty]

Read the coupons, they almost always have exclusions for medicare/medicaid/tricare.

Boom!

If you ask any reps if they have coupons, and specifically "exclusions" they'll say just government insurance. Usually since they are subsidized already..

 

[shaggybill]

Just curious, but if I'm not mistaken I believe I've read accounts of more established DPC providers offering things like labs, x-rays, DEXA, etc that are included in the monthly price. With the numbers that are usually thrown out (600 pts x 50/month), how is it feasible to offer all those services, eating the costs, and still keep the $220-240k income?

 

[deleted480308]

Just curious, but if I'm not mistaken I believe I've read accounts of more established DPC providers offering things like labs, x-rays, DEXA, etc that are included in the monthly price. With the numbers that are usually thrown out (600 pts x 50/month), how is it feasible to offer all those services, eating the costs, and still keep the $220-240k income?

Those are billed

 

[VA Hopeful Dr]

Those are billed

Not always. Most of those things are expensive to buy but not to use. On a smaller scale, my ECG machine was around $2500 to buy, but costs like 30 cents per use. Same idea with urine: the clinitek was about 5k, but each test strip is only around $2.

 

[deleted480308]

Not always. Most of those things are expensive to buy but not to use. On a smaller scale, my ECG machine was around $2500 to buy, but costs like 30 cents per use. Same idea with urine: the clinitek was about 5k, but each test strip is only around $2.

I guess not everyone bills, but I remember atlas referencing a price list for labs

 

[VA Hopeful Dr]

I guess not everyone bills, but I remember atlas referencing a price list for labs

Those were send out labs with Quest, I bill for those too. In house stuff, I don't and I don't think Atlas does either.

 

[mabinante]

Could you also not charge more than he suggests? Or less? Or different prices for patients based on their income level?

I am planning on charging more than some of the other DPC guys on this forum. I am in California and thus everything is at a premium here as far as my costs go.

I don't think charging different patients different amounts based on income level would go over well. I could see a day where the market begins to semi-saturate and you would have 2+ DPC practices in town that start to compete for business by lowering their prices.

 

[CircadianRhythm]

Not always. Most of those things are expensive to buy but not to use. On a smaller scale, my ECG machine was around $2500 to buy, but costs like 30 cents per use. Same idea with urine: the clinitek was about 5k, but each test strip is only around $2.

Do you feel you are able to get enough procedures to remain comfortable doing them with the lower case load?

 

[NontradCA]

I am planning on charging more than some of the other DPC guys on this forum. I am in California and thus everything is at a premium here as far as my costs go.

I don't think charging different patients different amounts based on income level would go over well. I could see a day where the market begins to semi-saturate and you would have 2+ DPC practices in town that start to compete for business by lowering their prices.

Wouldn't the market saturate rather quickly if there were multiple people in areas doing this? I think the % of people paying for care out of pocket is limited (I know a lot do already).

 

[VA Hopeful Dr]

Do you feel you are able to get enough procedures to remain comfortable doing them with the lower case load?

Yes. If I were doing anything complicated then I might be worried, but I'm not.

 

[VA Hopeful Dr]

Wouldn't the market saturate rather quickly if there were multiple people in areas doing this? I think the % of people paying for care out of pocket is limited (I know a lot do already).

Depends, but I tend to think not. In fact, there's something to be said for moving into an area where DPC is already a known entity.

 

[mabinante]

there's something to be said for moving into an area where DPC is already a known entity.

AtlasMD is a perfect example of that...Out in Wichita Kansas and in the surrounding areas it seems that DPC is booming...Would love to see a study of DPC per capita; my guess is Kansas would be the highest in the nation.

 

[alberrito]

Is it possible to dive right into DPC right after residency?

 

[Doctor4Life1769]

Is it possible to dive right into DPC right after residency?

Depends, I suppose.

If you're willing to take out loans, sure.

It's possible you could start up a small practice with minimal overhead, as well.

 

[VA Hopeful Dr]

Is it possible to dive right into DPC right after residency?

Yep. Many people are doing just that. I'm just over 2 years out, but my last year was pure Urgent Care so I'm no better off than a fresh grad in terms of existing patient base.

 

[shaggybill]

Yep. Many people are doing just that. I'm just over 2 years out, but my last year was pure Urgent Care so I'm no better off than a fresh grad in terms of existing patient base.

How are you faring income-wise having just started? Was the first year a real struggle?

 

[VA Hopeful Dr]

How are you faring income-wise having just started? Was the first year a real struggle?

I'm 4 months in, so yeah the first year does take some hard work.

The practice will not be paying me for many months (15 by my projections) so I'm moonlighting on the weekends to earn money.

 

[alberrito]

I'm 4 months in, so yeah the first year does take some hard work.

The practice will not be paying me for many months (15 by my projections) so I'm moonlighting on the weekends to earn money.

What would be a good way to start a DPC? Work for a group or hospital for a couple of years to establish a patient base then take these patients to your DPC clinic when you open?

 

[deleted480308]

What would be a good way to start a DPC? Work for a group or hospital for a couple of years to establish a patient base then take these patients to your DPC clinic when you open?

That sounds like a sh-- thng to do a group that gave you a job

 

[VA Hopeful Dr]

That sounds like a sh-- thng to do a group that gave you a job

Yeah, I would advise against doing that to a private group. Hospitals are a different story, because **** hospitals - but you have to be careful, most will have non-solicitation clauses in your contract and many have non-compete clauses that make doing this tricky.

 

[Ericslv]

Bottom line is if you want to go into business you will have to take the risk. Do your homework. Get help from really experienced DPC doctors and if you still want to do it then jump in. Like all business owner at the start you will work very hard moonlighting to pay for your personal expenses until your DPC takes off. If you have a wife and children you will not see them much and will work even harder at first.

If you stick it out and have done your homework right it will most likely make it and you will have a comfortable life after 3 to 5 tough, tough years.

 

[alberrito]

That sounds like a sh-- thng to do a group that gave you a job

What if i worked for 1 group then after a few years when my contract is up and i joined another group across town for various reasons and a lot of my patients followed me there, would it still be a crappy thing to do to the original group? My thinking is that a certain number of your patients will follow you wherever you go as long as you don't move too far out of their reach.

 

[deleted87716]

What if i worked for 1 group then after a few years when my contract is up and i joined another group across town for various reasons and a lot of my patients followed me there, would it still be a crappy thing to do to the original group? My thinking is that a certain number of your patients will follow you wherever you go as long as you don't move too far out of their reach.

Check your contract. There's probably a covenant not to compete in there, which would be in effect for a certain length of time (possibly up to 2 years) and geographic area (probably larger than "across town.") Unless the people running your group are *****s, of course.

 

[deleted480308]

What if i worked for 1 group then after a few years when my contract is up and i joined another group across town for various reasons and a lot of my patients followed me there, would it still be a crappy thing to do to the original group? My thinking is that a certain number of your patients will follow you wherever you go as long as you don't move too far out of their reach.

You know good and well what you are planning, don't be coy about it.

How would those patients, which you are paid by that group to see, find out where you are going? Are you going to tell them during the visit that the group is paying you for? Are you going to use that group's mailing list? If you pay me to service a bunch of your customers and then I use that trust to set up a competing business in town using your customers.....that you paid me to develop relationships with....then I'm an a****le. It's bad karma even if it doesn't violate a noncompete.

 

[Ericslv]

To the OP. Find where you want to practice and the practice you want to be in. If it doesn't work out because they are a holes to you then you usually have a way out in the contract (assuming you negotiate your contract well). If your intentions are to build a following on their dime and the bail on them, then you are screwing those people and if you stay in the same town everyone will know how you screwed them. Is that how you want your relationship to be with your colleagues in town?

 

[deleted87716]

Also, don't kid yourself that your patients will be loyal, especially if you've only been seeing them for a year or two. Your patients aren't seeing you because you're so great. You're just in a convenient location and accept their insurance.

 

[mabinante]

How would those patients, which you are paid by that group to see, find out where you are going? Are you going to tell them during the visit that the group is paying you for? Are you going to use that group's mailing list? If you pay me to service a bunch of your customers and then I use that trust to set up a competing business in town using your customers.....that you paid me to develop relationships with....then I'm an a****le. It's bad karma even if it doesn't violate a noncompete.

Worked with a doc that was getting screwed by his employer so he opened up shop right across the street. There is a workaround for "non-compete" and I have heard they are now obsolete in California...Especially when it comes to medicine. His lawyer told him that by law he has to be able to inform his patients of his new practice, for continuity of care and so as to not abandon his patients. I'm not saying it is the right thing to do, but I'm saying that if you leave your group, there will be a certain number of patients that will leave with you, naturally. I just signed a new UC contract here in CA...There is no non-compete but there is a non-solicit clause. I am able to inform my patients when I leave the UC (but really, who has UC patients that are "yours") via radio, TV or newspaper but not in person. It is pretty laughable.

 

[Ericslv]

Don't forget the possible liquidation clause.