Study: Small, Independent Practices Comprise Most Direct Primary Care Offices

FOR IMMEDIATE RELEASE: Monday, Nov. 9, 2015

Leslie Champlin
Senior Public Relations Strategist
(800) 274-2237, Ext. 5224 

WASHINGTON, DC — Everyone’s talking about direct primary care practices, but exactly what are they and how do they generate revenue streams? Moreover, what impact do they have on the cost and quality of patient care?

The answers to those questions become a bit more clear in Direct Primary Care – Practice Distribution and Cost Across the Nation(, a descriptive study that sheds light on the definitions of direct primary care, reviews monthly fees for the service and identifies characteristics of DPC practices. The research was published in the November-December Journal of the American Board of Family Medicine.

Study author Philip Eskew, DO, JD, MBA, a Robert Graham Center visiting scholar, and his colleague Kathleen Klink, MD, former medical director at the Robert Graham Center, gathered data on 141 primary care practices that met the study definition: a primary care practice that charges a periodic fee for services; does not bill any third parties on a fee-for-service basis; and limits any per-visit charge to less than the monthly periodic fee.

Among their findings:

  • Practices with four or fewer clinicians comprised 93 percent of those included in the study.
  • 84 percent of the DPC practices relied only on the monthly fee without any third-party fee-for-service payments.
  • 65 percent had opted out of Medicare.
  • Of the 116 practices that provided adequate cost information, the average monthly cost to the patient was $93.26; the median cost was $75, with a range of $26.67 to $562.50 per month.

The practices that described their service with the term “direct primary care” charged a lower monthly fee than practices that used the term “concierge,” to describe their models.

“I’m not too surprised that smaller practices make up the majority of direct primary care practices,” Eskew said. “In this context, being big often means being inefficient and slow to adapt to change. With direct primary care, you’re allowed to be nimble and responsive to what your patients want.”

DPC practice advocates say the model reduces insurance-related paperwork, saves time that can go to patient care and thus improves quality at less cost. But virtually no peer-reviewed studies have been published about the quality of DPC outcomes. This poses a challenge to greater dissemination of the model, according to Eskew.

“The movement has remained small,” Eskew said. “When you talk about it with people in academic medicine, for example, they’re unfamiliar with it. They say there’s no data on direct primary care. We hear the same feedback at state and federal policy levels as well.”

The authors called for additional research to determine whether direct primary care affected quality.

“Most DPC practices are young and small and thus lack sufficient quality and cost data to assess outcomes,” Eskew and Klink wrote. However, they pointed to two companies – Qliance and Access Healthcare – that had completed unpublished internal studies. Qliance reported a 50 percent reduction in emergency department visits, advance radiological testing and surgical procedures over traditional practices. The company also reported an increase in the number of primary care visits.

“The logical inference is one that primary care advocates have insisted is true in every health system – as utilization of low-cost comprehensive primary care increases, the need for high-cost emergency and specialty services declines,” Eskew and Klink wrote.

Access Healthcare also reported their patients spent 85 percent less out-of-pocket for their total cost of care when compared to the same level and amount of care in traditional settings.

“Proponents of DPC practices refer to these benefits regularly, but if the model is to be more widely adopted, more data is needed about DPC practices to document potential improvement,” they wrote. “DPC practices should be described using accurate and consistent terminology to minimize confusion, and continued efforts at price transparency at all levels are recommended.”


About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.