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   RE: Direct Primary Care
 From: Peter Liepmann
 To: Member Forum
 Posted: 11-26-2017 18:59
 Message: Hi Tracy,

generally practices 'cover' office procedures, plus vaccines thru their state program, and have a discount on labs/medicines.
Consider how you will run a 'hybrid' practice- the prepaid folks will have better access and get more services without visits- how will you distinguish between the the two populations?

Dr Forrest has an extensive set of DPC resources; I've attached some.
The Medicaid DPCs have been able to get by at ~$25/pmpm, w mostly younger patient populations.
The average FFS monthly DPC rate is more like $60-90 which has a lot of leeway built in.
A rate of $40-50 should be more than ok; you might want to say this includes up to 6 office visits per person a year, with some predefined rate after that.
The "average" patient makes 3.1 visits a year.  Of course we 'providers' mandate visits for lots of things that COULD be handled on the phone.

And as you know, a few very sick people use most of the health services in the US.
Office visits are MUCH LESS SKEWED than total spending.

Look at slide 4 from
Health Care's 1%: The Extreme Concentration of U.S. Health Spending
and compare the differences between top 1%, 10%  and the rest for total or hospital costs vs. office visits.  While the highest utilizers use more office visits than less ill folk, it's not as big a ratio as it is for total services.

Conclusion- taking capitation for office visits (DPC)  is much MUCH less risky than taking full capitation.

Article from 2015 on distribution of monthly fees:
doi: 10.3122/jabfm.2015.06.140337

Predicting Persistently High Primary Care Use

18% of visits are by patients using 10+/year
CONCLUSIONS: Many persistently high primary care users appear to be overserviced but underserved, with underlying problems not addressed by a medical approach. Some may benefit from psychosocial support, whereas others may be good candidates for disease management interventions."
Panel Size: How Many Patients Can One Doctor Manage?
(3.1 visits per year =>about 1800)

I hope this helps.

Peter Liepmann MD FAAFP MBA
My mission is to fix US health care
Bakersfield CA
Original Message:
Sent: 11-21-2017 17:51
From: Tracy Baum
Subject: Direct Primary Care


With the current ACA enrollment period in process and the significant rate hikes that patients are experiencing, we have decided to offer our uninsured patients DPC. Would anyone be willing to share how they structure this in a way that is beneficial for patients without the practice loosing their shirt? I know there will be 'super-users' but also those that really don't abuse the service.

Thank you!

Tracy Baum
Mountain Sage Family Clinic
Dubois, WY

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