As many Americans pay more for health insurance, more people are switching away from traditional fee-for-service payment models at their doctor’s office.
Dr. Jacques Bouchard is a family physician in Moscow, Idaho. He’s also one of a growing number of doctors whose patients pay a flat monthly rate instead of fee-for-service billing. The model is called direct primary care.
“In my practice, I get paid regardless,” he said. “In a fee-for-service, the only way physicians get paid is if someone walks through the door and is seen. So, you wouldn't get paid for phone notes. You don't get paid for reviewing labs. You don't get paid for thinking a little bit extra. ”
A national study published last month shows that the number of subscription-based health clinics increased by about 83% over five years.
The study looked at direct primary care, which does not accept insurance but offers a flat fee for unlimited access to a range of primary care. The practices often buy medications wholesale for patients, and contract with imaging centers for MRIs or X-rays.
The study also looked at growth in “concierge medicine,” which bills insurance in addition to charging a premium rate for services not covered by insurance, like in-home care, extended hours and direct access to doctors via phone.
“Direct primary care is sort of an affordable version of concierge medicine,” said Dr. Shaleah Jones, owner of Dawn MD, a direct primary care practice in Pullman, Washington.
Clinicians with direct primary care practices say that before switching from fee-for-service models, they were often waylaid by time limits on patient visits and working with insurance.
According to the American Academy of Family Physicians, 94% of physicians surveyed with a direct primary care practice indicated they were satisfied with their overall practice, compared to 57% satisfaction reported by the group that did not practice direct primary care.
“We also want to do a good job for our patients, and it's really, really hard to do that in the current health-insurance-driven-environment,” Jones said. “It's very time-consuming and frustrating to work with insurance companies.”
Jones sees over 400 patients at her clinic, where she’s been practicing direct primary care for about five years. She’s confident, she said, that her patients get better care than at a fee-for-service clinic.
One 2022 survey of patients using direct primary care seemed to indicate overall positive feelings about the model, with patients noting good communication, often over text, affordability of membership fees and inability to afford health insurance.
However, some patients still reported communication issues over phone calls, while others complained of difficulty accessing certain medications, as well as difficulty obtaining referrals to specialists.
Dewey Whiting started seeing Bouchard over a year ago. He said he likes that he has more access to his doctor and that the appointments feel personal. Direct primary care doctors typically see fewer patients than those working at fee-for-service clinics.
“I got on his portal, and he’s got a schedule. ‘I was like, ‘Oh my gosh, he's got appointments tomorrow,’” Whiting said. “I don't have to wait a month and a half to get in for a physical.’”
Researchers looking at the growth of subscription-based health care say more information is needed to understand how those changes could affect health care access. There is a possibility that the subscription-based models could contribute to health care shortages because doctors see fewer patients overall.
However, some direct primary care providers say their patient panel doesn’t tell the whole story.
“I think when you have time to spend with people where you can, you know they trust you and you understand their problems, they end up needing less time at a healthcare facility,” Jones said.
According to the American Academy of Family Physicians, direct primary care clinic fees typically range between $50 and $100 per month for adults. Many direct primary care clinics list their monthly rates on their website.
