243 Church St., NW 100C
Vienna, VA 22180
(T) 703-255-3067
(F) 703-382-6652
About Direct Primary Care (DPC)
DPC is an exciting model for primary care that is an alternative to the traditional insurance model. It offers a solution for what frustrates patients most these days: not being able to access your doctor when you need to, excessive waiting, rushed visits, and unpredictable costs.
DPC is not meant to replace insurance, as you will still need insurance for things like specialist visits and hospital services. You can also use your insurance for labs and diagnostic tests.
Service Advantages with DPC
1. Time saved and improved access to your doctor
In my DPC practice you get easy appointment access (same day or next business day), longer appointments when you need extra time, and short to no wait times in the office. You also gain the option to have consultations by phone call or email when medically appropriate, avoiding the inconvenience of an unnecessary face-to-face consultations, which are normally required in the insurance practice model. Remote consults can be used for the treatment of simple medical problems, fine-tuning established treatment plans, and having general information discussions. The result for you is time saved and access to your doctor in a patient- friendly way.
2. Personalized and unbiased care
Many medical offices have recently taken a “corporate” route in order to survive in the new doctor payment model called Value Based Care. This model was developed by Medicare and insurance companies to financially reward groups of doctors for saving money on the health care costs of large populations of patients.
In the Value Based Care model, the health of a large group of patients is given high priority. In my opinion this sometimes comes at the expense of your individual needs. Your office visit can become less personal and less meaningful, and a corporate third party intrudes into decisions that should be solely between you and your doctor.
My DPC office is privately owned and independent of insurance companies, hospitals, and large medical practice groups, removing conflicts of interest that could negatively impact your care. The result is medicine the way it should be: personalized and unbiased care that only prioritizes your interests.
FAQ
Do I have to pay co-pays or deductible costs for my appointment?
Fortunately the answer is no. Your membership covers the costs of services directly performed by me. Click here for details on what is included with membership.
Is DPC cost effective? Isn't it cheaper if I just use my insurance?
DPC service is so much better than the insurance model, but putting that aside studies show that the DPC model reduces the number of ER visits and specialist visits you will have. It also saves your time. These features are money savers.
Here is a link to data on a larger DPC company called Qliance which demonstrated 20% lower overall health care costs, including 14% fewer ER visits, 14% fewer specialist visits, and an average of $679 savings per patient per year, even considering the membership fee. Now not every patient will see $679 in actual out of pocket savings each year, but there is no question that fewer specialist and ER visits will reduce your out of pocket costs. According to a large area health insurer,BlueCross BlueShield, specialist costs account for 22.7% of our health care costs where as Primary Care Physicians account for only 5.7%. ER visits typically cost several hundred to several thousand dollars even if you have insurance.
With a DPC membership, there will be times that you will need to see a specialist, and emergencies do happen. However if you can prevent these situations form occurring unnecessarily by receiving high-quality primary care, there is certainly opportunity to save money.
DPC also can reduce costs for people with high deductibles that they would not expect to reach.
a. Office visits: DPC is most immediately cost effective if you have a high deductible health plans and you do not generally see doctors outside of primary care. Your membership fee is a predictable and reasonable primary care health cost that is very likely going to be less than your annual deductible. I have noticed that patients with high deductible plans tend to be reluctant to seek medical care, likely because of hard-to-predict out of pocket medical costs. With a DPC membership, you can again feel at ease reaching out to their doctor without needing to worry about incurring any additional consultation charges. Usually 4-5 doctor visits with a high deductible plan will pay for the membership. Example: an annual check up, visits surrounding a pneumonia, which can impact even heathy people, and one other visit for routine monitoring.
b. Labs and imaging: The DPC membership will also give you access to deeply discounted prices on lab and imaging studies, which I have negotiated on your behalf. In many cases these prices are better than what your insurance company negotiated. Having a choice in price allows you to be a smart health care shopper and get your testing done in the most economical way possible.
Having said all this, in my opinion the real value of the DPC membership is the incredible working relationship it fosters between you and your personal physician with long visits, thoughtful conversations, and the option to have virtual visits by telephone or email. I believe this level of service from a doctor who knows you well, and has the time to think carefully about your case is certainly worth $1.30-$3.30 per day.
Can I use my insurance for specialists, labs and other medical services if I want to?
Yes, unless you have Medicaid (government insurance for low income patients). Also HMO-style insurance plans require you to see an in-network primary care doctor to see a specialist.
Do I need to have insurance?
Yes, you need insurance because a DPC membership only covers primary care consultation services delivered by me directly. You need insurance for things like care from specialists, medical emergencies, and hospitalizations.
Is a DPC membership feasible if I have an HMO insurance plan?
It is more challenging but possible. You will basically need to maintain a relationship with an in-network HMO doctor in case you need a referral to a specialist. In my personal experience this is easiest with Kaiser but I have made it work before with other HMO plans. This issue will be handled on a case-by-case basis.
Is a DPC membership feasible if I have Medicaid (not Medicare for people over 65-see below for that)?
Given the logistical difficulty HMO plans present with ordering studies and arranging consults with specialists, I cannot accept patients with HMO plans or Medicaid.
Is a DPC membership feasible if I have Medicare?
Yes. You will need to sign an agreement stating you understand I have opted out of Medicare and that you will not submit my charges to Medicare for reimbursement.
How is DPC different from a Concierge medical practice?
Mostly cost. Concierge practices in our area generally charge $150-$180 per month or more for an annual physical and improved doctor access. They also bill your insurance for each in-person visit which means you incur co-payments and deductible costs each time you see the doctor on top of your monthly fee. DPC keeps it simple--one fair and reasonable monthly price for all the doctor visits you need without co-pays or deductibles.
Also a key part of DPC is a spirit of helping patients navigate the financial aspect of their care by researching the best prices for labs, imaging studies, and medications. These cost savings add value to the membership and sometimes even equate to the cost of the membership itself!
What does my membership include?
Please click here for membership details.
Can I pay for my membership with my Flexible Spending Account (FSA)?
This depends on the rules of your FSA as set by your employer. Please contact your HR department to ask this question. We will provide any necessary supporting documentation.
Does a DPC membership prevent me from contributing to a Health Savings Account (HSA)?
I recommend asking your accountant or tax advisor, as this involves interpretation of IRS code section 223(c)(1)(A)(ii). This section indicates that in order to maintain an HSA you are not allowed to have a second health plan. In 2017 a law was passed in Virginia specifically stating that a DPC membership is not an insurance plan (See Virginia Code 54.1-2997). However ultimately this is an IRS issue and it is for this reason that I recommend getting counsel from an accountant to answer this question.
Can I pay for my membership with my Health Savings Account (HSA)?
I also recommend asking your accountant about this, to interpret IRS Publication 502 Medical and Dental Expenses. In this manual medical expenses are defined as the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body.
Can I submit a claim to my insurance for my DPC membership fee?
You certainly can check with your insurance plan, but I do not expect they will reimburse you for this.
DPC is an exciting model for primary care that is an alternative to the traditional insurance model. It offers a solution for what frustrates patients most these days: not being able to access your doctor when you need to, excessive waiting, rushed visits, and unpredictable costs.
DPC is not meant to replace insurance, as you will still need insurance for things like specialist visits and hospital services. You can also use your insurance for labs and diagnostic tests.
Service Advantages with DPC
1. Time saved and improved access to your doctor
In my DPC practice you get easy appointment access (same day or next business day), longer appointments when you need extra time, and short to no wait times in the office. You also gain the option to have consultations by phone call or email when medically appropriate, avoiding the inconvenience of an unnecessary face-to-face consultations, which are normally required in the insurance practice model. Remote consults can be used for the treatment of simple medical problems, fine-tuning established treatment plans, and having general information discussions. The result for you is time saved and access to your doctor in a patient- friendly way.
2. Personalized and unbiased care
Many medical offices have recently taken a “corporate” route in order to survive in the new doctor payment model called Value Based Care. This model was developed by Medicare and insurance companies to financially reward groups of doctors for saving money on the health care costs of large populations of patients.
In the Value Based Care model, the health of a large group of patients is given high priority. In my opinion this sometimes comes at the expense of your individual needs. Your office visit can become less personal and less meaningful, and a corporate third party intrudes into decisions that should be solely between you and your doctor.
My DPC office is privately owned and independent of insurance companies, hospitals, and large medical practice groups, removing conflicts of interest that could negatively impact your care. The result is medicine the way it should be: personalized and unbiased care that only prioritizes your interests.
FAQ
Do I have to pay co-pays or deductible costs for my appointment?
Fortunately the answer is no. Your membership covers the costs of services directly performed by me. Click here for details on what is included with membership.
Is DPC cost effective? Isn't it cheaper if I just use my insurance?
DPC service is so much better than the insurance model, but putting that aside studies show that the DPC model reduces the number of ER visits and specialist visits you will have. It also saves your time. These features are money savers.
Here is a link to data on a larger DPC company called Qliance which demonstrated 20% lower overall health care costs, including 14% fewer ER visits, 14% fewer specialist visits, and an average of $679 savings per patient per year, even considering the membership fee. Now not every patient will see $679 in actual out of pocket savings each year, but there is no question that fewer specialist and ER visits will reduce your out of pocket costs. According to a large area health insurer,BlueCross BlueShield, specialist costs account for 22.7% of our health care costs where as Primary Care Physicians account for only 5.7%. ER visits typically cost several hundred to several thousand dollars even if you have insurance.
With a DPC membership, there will be times that you will need to see a specialist, and emergencies do happen. However if you can prevent these situations form occurring unnecessarily by receiving high-quality primary care, there is certainly opportunity to save money.
DPC also can reduce costs for people with high deductibles that they would not expect to reach.
a. Office visits: DPC is most immediately cost effective if you have a high deductible health plans and you do not generally see doctors outside of primary care. Your membership fee is a predictable and reasonable primary care health cost that is very likely going to be less than your annual deductible. I have noticed that patients with high deductible plans tend to be reluctant to seek medical care, likely because of hard-to-predict out of pocket medical costs. With a DPC membership, you can again feel at ease reaching out to their doctor without needing to worry about incurring any additional consultation charges. Usually 4-5 doctor visits with a high deductible plan will pay for the membership. Example: an annual check up, visits surrounding a pneumonia, which can impact even heathy people, and one other visit for routine monitoring.
b. Labs and imaging: The DPC membership will also give you access to deeply discounted prices on lab and imaging studies, which I have negotiated on your behalf. In many cases these prices are better than what your insurance company negotiated. Having a choice in price allows you to be a smart health care shopper and get your testing done in the most economical way possible.
Having said all this, in my opinion the real value of the DPC membership is the incredible working relationship it fosters between you and your personal physician with long visits, thoughtful conversations, and the option to have virtual visits by telephone or email. I believe this level of service from a doctor who knows you well, and has the time to think carefully about your case is certainly worth $1.30-$3.30 per day.
Can I use my insurance for specialists, labs and other medical services if I want to?
Yes, unless you have Medicaid (government insurance for low income patients). Also HMO-style insurance plans require you to see an in-network primary care doctor to see a specialist.
Do I need to have insurance?
Yes, you need insurance because a DPC membership only covers primary care consultation services delivered by me directly. You need insurance for things like care from specialists, medical emergencies, and hospitalizations.
Is a DPC membership feasible if I have an HMO insurance plan?
It is more challenging but possible. You will basically need to maintain a relationship with an in-network HMO doctor in case you need a referral to a specialist. In my personal experience this is easiest with Kaiser but I have made it work before with other HMO plans. This issue will be handled on a case-by-case basis.
Is a DPC membership feasible if I have Medicaid (not Medicare for people over 65-see below for that)?
Given the logistical difficulty HMO plans present with ordering studies and arranging consults with specialists, I cannot accept patients with HMO plans or Medicaid.
Is a DPC membership feasible if I have Medicare?
Yes. You will need to sign an agreement stating you understand I have opted out of Medicare and that you will not submit my charges to Medicare for reimbursement.
How is DPC different from a Concierge medical practice?
Mostly cost. Concierge practices in our area generally charge $150-$180 per month or more for an annual physical and improved doctor access. They also bill your insurance for each in-person visit which means you incur co-payments and deductible costs each time you see the doctor on top of your monthly fee. DPC keeps it simple--one fair and reasonable monthly price for all the doctor visits you need without co-pays or deductibles.
Also a key part of DPC is a spirit of helping patients navigate the financial aspect of their care by researching the best prices for labs, imaging studies, and medications. These cost savings add value to the membership and sometimes even equate to the cost of the membership itself!
What does my membership include?
Please click here for membership details.
Can I pay for my membership with my Flexible Spending Account (FSA)?
This depends on the rules of your FSA as set by your employer. Please contact your HR department to ask this question. We will provide any necessary supporting documentation.
Does a DPC membership prevent me from contributing to a Health Savings Account (HSA)?
I recommend asking your accountant or tax advisor, as this involves interpretation of IRS code section 223(c)(1)(A)(ii). This section indicates that in order to maintain an HSA you are not allowed to have a second health plan. In 2017 a law was passed in Virginia specifically stating that a DPC membership is not an insurance plan (See Virginia Code 54.1-2997). However ultimately this is an IRS issue and it is for this reason that I recommend getting counsel from an accountant to answer this question.
Can I pay for my membership with my Health Savings Account (HSA)?
I also recommend asking your accountant about this, to interpret IRS Publication 502 Medical and Dental Expenses. In this manual medical expenses are defined as the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body.
Can I submit a claim to my insurance for my DPC membership fee?
You certainly can check with your insurance plan, but I do not expect they will reimburse you for this.