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Warily, ACP Eyes New Primary Care Model

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   November 12, 2015

Physicians who practice in concierge and direct primary care models have been put on notice by the American College of Physicians, which warns against creating barriers to care, particularly for low-income and minority patients. DPC physicians say the ACP has it all wrong.

New care models, such as direct primary care (DPC) emphasize that the doctor-patient relationship can be a lifeline to physicians who are burned out, stressed out, and thinking about getting out. But the American College of Physicians isn't sold on the idea.

Omar Durani, MD

The ACP's medical practice and quality committee released nine recommendations in the Annals of Internal Medicine for "direct patient contracting practices," an ACP term that lumps DPC, cash-pay, and concierge practices together. Though the recommendations neither endorse nor reject those models, some DPC physicians are upset the models are grouped together in the first place.

"The ACP draft inaccurately lumped concierge/boutique, cash-only and DPC as one entity, and questioned the ethics of such physicians, which we do not agree with," says Omar Durani, MD, a DPC physician. Durani and his partner Howsen Kwan, MD, are about to open their first DPC practice in Dallas next month.

Normally, I don't split hairs over semantics, but in this case, Durani and Kwan have a point. DPC and concierge models are very different. DPC is an offshoot of the well-established concierge practice model. Both types of practices charge patients a fee in exchange for longer appointment times and 24/7 access. Concierge and DPC physicians also have smaller patient panels.

But that is where the similarities end.

Concierge practices are expensive. Their annual fees can run in the thousands of dollars and their patients typically carry traditional health insurance policies. DPC practices charge a monthly fee that can range from $10 to $99 per month and their patients are usually insured by a major medical policy only.

Both models and cash-only practices have a place in patient care because patients are using them. This key variable is often overlooked, and in many ways the DPC model is growing in popularity because it is meeting patients' needs.


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Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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