The direct primary care model, which charges a regular membership or retainer fee to patients for primary care services, has been rapidly adopted in private medical practices across the United States, and is quickly replacing the traditional fee-for-service payment model.

In an article published in JAMA, Rita Rubin, MA, senior medical news and perspectives writer for JAMA, discusses the benefits, potential pitfalls, current trends, and future directions of this innovative patient payment strategy.

In a direct primary care payment model, physicians will typically avoid accepting insurance and will often reduce the size of their practice to only several hundred patients. In doing so, clinicians are allowed to practice primary care medicine on their own terms vs at the dictation of private payers.

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Although the direct primary care model represents a boon for clinicians wishing to reduce hectic schedules and increase care efficiency, there are few data available that analyze the real-world advantages of such a scheme, specifically as it relates to clinician accessibility, costs, and care quality among patients. This lack of data necessitates the creation of a randomized clinical trial (eg, direct primary care vs fee-for-service model) to determine a meaningful effect of the payment approach.

One concern related to the direct primary care model is the potential for it to worsen the primary care physician shortage. Despite this concern, proponents of the initiative suggest that the model will attract future doctors to pursue primary care, as well as entice older physicians to continue in primary care after burnout in the fee-for-service payment model.

At this time, the Centers for Medicare & Medicaid Services are expressing interest in the direct primary care model for Medicare beneficiaries, particularly for improving the doctor-physician relationship, which is often hindered under heavily regulated payment structures. Variation exists, however, in the acceptance of Medicare beneficiaries among direct primary care practices. In the coming years, the fate of direct primary care models will depend on the public’s acceptance of high-deductible health plans.

Although concierge medicine is often mistaken for direct primary care, the 2 models are marked by glaring distinctions. “The biggest difference,” writes Ms Rubin, “is that neither [direct primary care] physicians nor their patients file insurance claims for primary care, unlike concierge physicians.”


Rubin R. Is direct primary care a game changer? [published online May 2, 2018]. JAMA. doi : 10.1001/jama.2018.3173.