Page 4 - Kansas Journal of Medicine, Volume 10 Issue 1
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KANSAS JOURNAL of M E D I C I N E                                  Conclusions. Most DPC practices no longer submit to in-
                                                                      surance and are family medicine trained. Compared
     Direct Primary Care in 2015: A Survey with                       with the previous sampling, DPC practices report de-
     Selected Comparisons to 2005 Survey Data                         creased membership fees and increased projected pan-
                                                                      el size. These trends may signify the DPC movement’s
    Kyle Rowe, M.D.1, Whitney Rowe, M.D.2, Josh Umbehr, M.D.3,        growth in application and scope. KS J Med 2017;10(1):3-6.
            Frank Dong, Ph.D.4, Elizabeth Ablah, Ph.D., MPH5
                                                                      INTRODUCTION
          University of Kansas School of Medicine-Wichita, KS         	 Direct primary care (DPC), also known as “concierge medi-
                       1Department of Internal Medicine               cine,” has been increasing in popularity since the early 2000s.1-3
                                                                      The practice discipline is based on the premise that the develop-
       2Department of Family and Community Medicine, Family           ment of a high quality patient-physician relationship is enhanced
        Medicine Residency Program at Wesley Medical Center           in an environment that provides unrestricted access, innovative
            3Atlas MD Concierge Family Practice, Wichita, KS          and open communication, and increased face-to-face time. Pa-
          4Western University of Health Sciences, Pomona, CA          tients pay a practice determined membership fee, at varying
                                                                      intervals ranging from monthly to annually, in exchange for a
   5University of Kansas School of Medicine-Wichita, Department       variety of included amenities and services which are intended
         of Preventive Medicine and Public Health, Wichita, KS        to support this premise.4 Patients are attracted to this model for
                                                                      the simplicity, and the quality of the relationship they poten-
   ABSTRACT                                                           tially can build with their physicians.1 The patient’s preventive
   Introduction. Direct primary care (DPC), a fee for member-         care becomes the primary focus. It follows that there should
   ship type of practice, is an evolving innovative primary care      be a decreased disease burden, decreased utilization of acute
   delivery model. Little is known about current membership           care, inpatient, and specialist services, thus decreased health
   fees, insurance billing status, physician training, and patient    care cost. Decreased numbers of emergency department visits,
   panel size in DPC practices. This study aimed to obtain cur-       as well as decreased inpatient admissions, can occur among
   rent data for these variables, as well as additional demographic   Medicare beneficiaries utilizing a direct primary care model.5
   and financial indicators, and relate the findings to the Healthy   	 In October 2014, the Centers for Medicare and Medicaid Ser-
   People 2020 goals. It was predicted that DPC practices would       vices (CMS) dedicated $840 million in grant support for pri-
   (1) submit fewer claims to insurance, (2) have decreased mem-      mary care innovation, one component of which was specified
   bership fees, (3) be primarily family medicine trained, and        as initiatives developing and testing new payment and service
   (4) have increased the projected patient panel size since 2005.    delivery models.6 This sizable commitment may aid in achiev-
                                                                      ing the Healthy People 2020 goals of increased supply, access,
   Methods. An electronic survey was sent to DPC prac-                and utilization of primary care services.7 In an environment of
   tices (n = 65) requesting location, membership fees, pro-          high primary care burnout,8 innovative models that promote
   jected patient panel size, insurance billing status, train-        greater balance between work and home-life, at similar levels
   ing, and other demographic and financial indicators. Data          of compensation, will become more needed to increase the sup-
   were aggregated, reported anonymously, and compared to             ply of primary care physicians. Additional study in the DPC
   two prior characterizations of DPC practices done in 2005.         style of practice will facilitate further innovations toward these
                                                                      ends and will aid emerging physicians’ choices of specialty and
   Results. Thirty-eight of 65 (59%) practices responded to the       practice models. In 2005, previous researchers analyzed mul-
   2015 survey. The majority of respondents (84%) reported using      tiple components of DPC practices including the membership
   an EMR, offering physician email access (82%), 24-hour access      fees, insurance billing status, projected panel size, and special-
   (76%), same day appointments (92%), and wholesale labs (74%).      ty.9,10 Little is known about the change in the aforementioned
   Few respondents offered inpatient care (16%), obstetrics (3%),     practice characteristics from 2005 to 2015. These specific points
   or financial/insurance consultant services. Eighty-eight percent   are relevant to understanding the growth and development of
   (88%) of practices reported annual individual adult member-        DPC. Therefore, this survey aimed to obtain these current data
   ship rates between $500 and $1,499, decreased from 2005 where      points, obtain additional demographic and financial indicators,
   81% reported greater than a $1,500 annual fee. The proportion of   and relate the findings to the Healthy People 2020 goals. It was
   practices who submit bills to insurance decreased from 75% in      predicted that DPC practices would (1) submit fewer claims to
   2005 to 11% in 2015. Fifty-six percent (56%) of practices report-  insurance, (2) have decreased membership fees, and (3) have in-
   ed projected patient panel size to be greater than 600, increased  creased the projected patient panel size since the last evaluation.
   from 40% in 2005. Family medicine physicians represented 87%
   of respondents, markedly different from 2005 when 62 - 77% of
   DPC respondents were general internal medicine physicians.

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