Direct Primary Care – A Primer
What is Direct Primary Care (DPC)?
DPC is an innovative primary care model of medicine in which the physician-patient relationship is at the heart of how medicine is practiced. DPC practices offer a full range of primary care services for a monthly or annual retainer fee paid directly to the practice.
How does a DPC practice differ from a traditional primary care practice?
In a traditional primary care practice, doctors are compensated based on how they code and the quantity of patients they see, rather than based on the quality of care that they provide. In a DPC practice, quality of care is the number one priority. By cutting down on the panel size of patients from approximately 2500 patients to 600-800 patients, doctors working in a DPC practice are able to spend unlimited time with patients; patients have easier access to appointment times that meet their scheduling needs; patients are guaranteed to see their doctor, not another provider; patients are able to reach out to their doctor via e-mail and cell phone. These are just some of the benefits of a DPC practice.
What role does insurance play in a DPC practice? Will Gold Direct Care accept insurance?
Insurance has no role in a DPC practice, therefore Gold Direct Care will not be accepting insurance. Gold Direct Care will charge a flat monthly or annual fee that will cover all comprehensive primary care services. The patient will still need to retain an insurance policy in the event of catastrophic illness or hospitalization. At Gold Direct Care we recommend a high deductible insurance plan with a lower monthly premium as we have discounted labs done on site, reduced imaging fees at outside sites, and reduced generic medication prices at a local pharmacy. We can also work with you to customize an insurance plan that works in conjunction with DPC.
Is DPC Insurance and does it replace insurance?
No it is not insurance nor does it replace it as stated above. Insurance is an important part of specialist and hospital care. Similar to automobile insurance, our health insurance system was originally designed to pay for rare, unpredictable, and extremely expensive problems. It is essential when patients need emergency care or an operation and chemotherapy treatments, care provided by specialists and hospitals.
Can I use my insurance elsewhere if I join Gold Direct Care?
Your insurance plans will continue to operate “as usual” at other doctors’ offices, hospitals and pharmacies. Some plans do not require a designated “gatekeeper” doctor for referrals, medications, tests, and the like, so Gold Direct Care can order those services as needed just as any other doctor would do. Some HMO-style plans do require an “in-network” primary care doctor for access to other services, so these plans do not pair as well with membership at Gold Direct Care. Please check with your insurance company.
What if I need to be referred to a specialist?
The hope is that by spending more time with your primary care physician, the need to refer you to a specialist will decrease significantly. However, in the event that you do need to be referred to a specialist, Dr. Gold will personally call the specialist on your behalf in order to schedule an expedited appointment. Gold Direct Care will also be offering a service called RubiconMD that does online consultations with some of the top specialists in all fields from teaching hospitals across the country. Dr. Gold will also continue to work with all of the NSMC/MGH specialists in the area.
What is the impact on Medicare patients?
At Gold Direct Care, we accept patients that are on Medicare; however, we do not bill Medicare, nor can the patient bill Medicare for primary care services that we provide. Medicare will still cover any laboratory testing, imaging, medications, referrals to specialists, and hospitalizations. Our consultants at Medfirst Partners can also answer more specific questions regarding Medicare as this can be very confusing for patients and we want to simplify this as much as possible.
What services are included with membership?
Your annual physical exam; up to 12 sick visits throughout the year; guaranteed same-day or next-day appointments; access to Dr. Gold via his personal cell phone and e-mail. E visits through Skype, FaceTime, etc are also included.