1 Comment

  1. I would like to echo and expand on Dr. Bliss’s closing comments.

    While debating enrollment numbers and fee structures, let’s not forget that DPC is about more than simply changing the way doctors get paid by using a monthly fee or being more efficient. It is primarily about WHO pays the doctor and who we really work for.

    Sure, it is about ridding ourselves of the perverse incentives and non-clinical expense related to the old way of billing. But fundamentally, the DPC model allows us to take back our independence as sovereign practitioners and re-establish the preeminence of the doctor-patient relationship as the foundation of good primary care. As Atlas MD says, we “shrugged the bureaucracy”

    One of the many economic distortions and perversions of third-party paid medical care is that the recipient of the care (the patient) has not been the main consumer of the care. This resulted in the discussion never being about price when insurance was paying the bill and always about price (inflated billed CPT charges) when insurance wasn’t paying. It also created artificial demand, an inflationary spiral of costs, a lack of price transparency and mythical PPO discounts based off of fictitious charges. The third-party payment system, catalyzed by Medicare, was the seed of most of our woes today in healthcare. It made the discussion always about “coverage” and not about care or the real costs of care.

    One of the most attractive feature of DPC, and any non-third-party model, is that it it permits the doctor to work directly for his or her patients; not as a subcontractor or surrogate of the third-party payer.

    To be sustainable long-term, Medicaid and Medicare must transition to a defined contribution model or something very similar for routine preventative and primary care. Once we get to a point where “safety net” money follows people, not programs, then those funds can be used freely by choice by the recipients to enroll in DPC or pay for FFS care in the private sector or at designated public clinics. That scenario will be the closest we get to a real market and represent near neutrality by government payers.

    Allowing a third-party, be it government or private, to pay us a negotiated monthly fee on behalf of a panel of patients opens the door to third-party dominance once again.

    Yes, employers will play a role and even offset costs for some employees, even within a DPC model; but I hope that the advent of DPC will spell the end of the need for expensive COBRA “coverage” by making it affordable for patients to stay on even if they change employers.

    Having the individual patients serve as the collective employer of the doctor is the beauty of DPC and it what sets it apart from every other model. Let’s not forget this as we move forward.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s