Direct Primary Care Is Gaining Traction

By Rachael Zimlich, Medical Economics, July 2013

As he was nearing the midpoint of his career in family medicine at the Mayo Clinic, David Usher, MD—like many primary care physicians—knew something was missing from his professional life, and his personal life.

He found his answer in 2010 after reading an article in Medical Economics about a direct-pay primary care practice in North Carolina.

“I was experiencing the same thing a lot of PCPs are. The system just over time ratcheting down what you get paid and forcing you to work harder and harder to get it,” Usher says, adding there was too much hassle to get paid and patients couldn’t afford the care he was recommending.

He showed the article to his wife, and that’s when his life changed.

Nearly 2 years later, he built an independent family practice in Wisconsin, ReforMedicine, to about 2,000 patients that he describes as “loyal and happy.” Yet Usher says he is starting to feel some of the same old pressures. “You’re continuously looking at the bottom line and how many patients you are seeing a day and counting the dollars,” Usher says.

Squeezing as many patients as possible into a day and having to be more focused on which codes will result in the highest reimbursements isn’t the kind of practice many physicians envision. For physicians whose ideal was simply hanging a shingle out, the outlook is even worse.

The number of independent physicians dropped from 57% in 2000 to 39% in 2012, and those that are left are looking to new practice models to hold their ground, according to the Accenture Physicians Alignment Survey.

Accenture estimates that one in three remaining independent physicians—their ranks decline by 5% each year—will look to adopt subscription-based practice models (concierge medicine) to achieve higher yields, and that trend will continue to increase by 100% annually over the next 3 years.

The survey also included some of the top reasons physicians give for leaving independent practices to be employed elsewhere. The cost and expense of running a business was cited as the main reason for leaving independent practice by 87% of physicians surveyed. Another 61% cited dealing with managed care, 53% cited electronic health record (EHR) problems, another 53% cite maintaining and managing staff, and 39% cite the volume of patients they have to see to break even on overhead.

Although there are many ideas on how to save primary care in the face of an onslaught of new patients created by the Affordable Care Act (ACA), burnout and declining reimbursements, there are no clear solutions. But direct primary care—a more affordable version of concierge medicine—is gaining traction.


What is direct primary care?

Running a direct pay practice

Making the transition 

Aid Available

The Difficulties Involved

Future Challenges,0#sthash.48jdxSVj.dpuf

Dr. David Usher’s Practice:

ReforMedicine – Bariatrics and Family Practice
Red Cedar Plaza, Suite 303
2321 Highway 25 North
Menomonie, WI 54751
Phone: (715) 231-3040

About Concierge Medicine Journal

Concierge Medicine Journal (CMJ) curates breaking concierge medicine news, and editorial opinion on a wide variety of topics relevant to the practice of Concierge Medicine.

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