8 Differences Between Direct Primary Care and Concierge Medicine

Apples and oranges are both round and are fruits, yet they are very different things. Direct Primary Care and Concierge medicine are like apples and oranges. They have some features that are alike, but they are completely different models of health care delivery.

Both DPC and Concierge medicine accept payments directly from their patients, both have smaller panel sizes, and both use multiple modes of communication with their patients (phone, text, email, portal). Beyond that there are several key differences between the two.

1. The "Membership Fee" Concierge medicine practices usually charge an annual fee. DPC membership fee is usually charged monthly, quarterly, or annually--whichever the patient prefers.

2. Average Membership cost. Concierge doctors often charge much higher fees than the average DPC doctor. Concierge medicine fees can range from around $1800/year to as much as $25,000 for one year! Average DPC fees run around $900-$1500 per year.

3. Insurance. Usually, Concierge doctors still bill your insurance for your visits in addition to your annual fee. You might get "surprise bills" a few months later after your insurance pays their portion of the bill, often without any prior knowledge of how much you will be charged. DPC doctors do not bill insurance, period.

4. Copays at your visit. Concierge medicine practices are required to collect co-pays at each visit because they also accept insurance. DPC practices do not bill insurance so there are no co-pays per visit.

5. Patient Panel Size. Both DPC and Concierge doctors typically have a panel of 600 patients or less. Both can have longer, more involved appointments with their patients, which makes both the patients and doctors happier and more satisfied with the experience.

6. Insurance Regulation. Concierge doctors have to adhere to several insurance regulations and documentation requirements like MACRA/MIPS, meaningful use, etc. DPC doctors do not bill insurance and therefore are not required to follow these regulations. They can spend more of their time on patient care and not on checkbox documentation.

7. Office overhead costs. Typically, concierge practices have high overhead costs, partly because they do accept insurance. For this reason, the care provided in these practices tends to be more expensive. DPC physicians do not require large numbers of staff to negotiate insurance contracts, bill insurance, process insurance payments and resubmit bills when insurance balks at paying due to coding issues. Without the need for many staff members, DPC practices have very low overhead and can offer lower monthly membership fees.

8. Patient populations. Concierge practices typically serve wealthier patients, because they have insurance and can afford the high yearly fees. DPC doctors serve everyone. DPC practices have been called "Blue collar concierge practices". As long as patients can pay the monthly fee, it doesn't matter whether or not they have insurance. Anyone can benefit from the quality care offered by DPC doctors. They will see people with insurance and those who make too much money to qualify for government assistance, but not enough money to purchase insurance on their own.

I hope that clears up some of the confusion between the two types of models. Emerald Health Direct Primary Care is NOT a concierge practice. We provide quality Direct Primary Care, accessible to all at a more affordable cost.

Anne Gonzalez, MD
Emerald Health Direct Primary Care