Practicing direct primary care with an integrative focus

Photo Cred: StockSnap/Pixabay

By Wendy Pecoraro, MSN, APRN, DipACLM

In our integrative care practices, we convey the importance of downtime, mindfulness, movement, sleep, spending time in nature, and fostering meaningful relationships. Often though, we find ourselves too “busy” to follow our own recommendations. One answer my practice has found to ease the time crunch and increase cashflow is to partner with a Direct Primary Care (DPC) company.

It can be challenging to make a profit in an insurance-based integrative medicine practice. The integrative practice model is designed to provide longer, more in-depth visits than those patients seen in a primary care clinic, where revenue is generated by the sheer volume of patients seen. My team of family nurse practitioners (FNP) and I work as contractors at Omaha Integrative Care (OIC), an integrative practice that functions as a collective of many health-related disciplines.

In March 2018, the FNP team contracted with a local DPC company to provide direct primary care services to augment the income from our fee-for-service practice. DPC is an alternative payment model where patients can access healthcare with a flat membership fee. The DPC model charges patients monthly, quarterly, or annually. While most primary care services are typically covered, our practice recommends a supplemental, high-deductible plan to cover services that do not fall under the umbrella of primary care.

The membership fees for DPC are less than that of a Concierge Practice, typically, $1,200 to $2,000 per year with discount for subsequent family members enrolled. At first glance, that doesn’t seem like much, but consider that this is consistent income. Patients pay a monthly fee of $100 whether they are seen in the clinic or not. Our goal is to have 300 patients per practitioner, which amounts to $360,000 per year per practitioner minus the annual lab work that’s included with their subscription, which totals $10,000 for 300 patients because of the low contracted price through a local laboratory.

If patients need lab work outside of their annual labs, for instance, they are charged a discounted rate through our clinic. If they need imaging studies, they pay the facility that has the contract with the DPC company. A CT scan at this facility costs approximately $375 and a chest x-ray is $45. These charges are discussed with the patient prior to the service and payment is made at the time of service.

Since we are contracted, our FNPs get paid a percentage of the subscription fee for each DPC patient. The percentage retained by the DPC company pays for recruitment of patients, tracking subscriptions, maintaining contracts, data collection, legislative advocacy, and administrative and physician support if needed. These benefits are why we chose to partner with an existing DPC company rather than start a DPC within our practice.

DPC Benefits to Patients

• 24/7 Access to Practitioner
• Communication via an app on phone
• Savings by to choose a high deductible insurance plan combined with DPC
• Annual lab work covered in subscription fee
• Contracted discounts on medication, lab work, imaging studies, physical therapy, yoga, massage, meditation, and more

DPC Benefits to Practitioners

• Flexible schedule and structure
• More time with patients
• Less administrative time because of cash services rather than third-party payers
• Less administrative cost
• Consistent cashflow

A HIPAA-protected app allows our DPC patients to contact their practitioner 24/7 and has the capability to send pictures, which can help us triage lacerations, rashes, and other similar conditions. There were concerns amongst our practitioners about this unlimited access, but we are only paged outside of office hours approximately four time per month. As our volume increases, we may consider a call schedule.

DPC doesn’t require any different clinical skills than an integrative practitioner uses daily. Both practices provide a foundational approach that emphasizes quality time devoted to the development of meaningful relationships with each patient and start with lifestyle modification as prevention or treatment of chronic disease. There are practitioners who keep standard hours under this practice model and there are others who work three days a week or only when they have a patient scheduled. There are those who make house calls or use telemedicine. The schedule flexibility allows time for other pursuits or some much needed downtime.

While it presents its own set of challenges, we have found DPC to be a complement to our integrative practice. Our DPC patients and practitioners are highly satisfied with the model because it preserves the integrity of our integrative care practice. It provides an additional source of income without decreasing access to care by transitioning to a concierge model or cash-based practice.