Direct Primary Care (DPC)

Direct Primary Care (DPC) is an innovative alternative payment model that improves access to high-quality healthcare with a simple, flat, and affordable membership fee. No fee-for-service payments; No third-party billing; Removing the middlemen hindering medical care.

This revolution in healthcare allows this magic spark of fostering time to build enduring, trusting, relationships between a patient and their primary care provider. This allows the patient to access comprehensive services, increased access, and enhanced care from your physician. Lastly, this model keeps your doctor independent from large corporations and insurance companies.

Key Features of Direct Primary Care

• Multiple Primary Care Services provided directly to the patient:
  • In-office procedures, EKGs, lung testing, ear-wax removal, etc.
• Concierge Level Care for one flat monthly fee:
  • Extended appointments
  • Same or next-day appointments (generally available)
  • Unrestricted access to your primary care provider through call, email, text, telemedicine/video call visits

Direct Primary Care is not a new way of medicine. It is a membership-based model of healthcare that has been around for years, where members pay a fixed, monthly fee to receive unrestricted access to their Primary Care Doctor. Not what you’re used to? It is actually better. Like your gym membership or Netflix, for a low monthly fee (that will likely save you money), you get unlimited appointments and easy, quick access to Dr. Tocidlowski whenever you need, even if you do not have insurance.

If you are uninsured, what happens when lack of any care leads to a single $350 urgent care appointment, or worse from the ER? Direct Primary Care is a revolution for both insured and uninsured persons, and the future of high quality primary care.

The Problem with Fee-for-Service Medicine

The "traditional" fee-for-service model is broken. It has the wrong incentives, pushing for more treatments and unnecessary follow-up visits rather than focusing on your well-being.

"Surprise billing" is another significant issue in traditional healthcare, with unexpected facility fees and balance billing, despite estimate mandates. Patients often have to pay the remainder of what insurance doesn't cover, leading to unpredictable and high out-of-pocket costs.

In contrast, Direct Primary Care is incentivized to keep you healthy and out of the doctor's office as much as possible. This means you are more likely to seek timely, appropriate treatment without the fear of high medical bills.

Better Scheduling, Better Appointments

Most doctor visits only last for 8 minutes, and in our community, it can take 6 weeks or more to get a routine doctor's appointment. This means that a doctor may see 20-40 patients per day, and the care becomes rushed.

While I previously worked in a fee-for-service practice, I was booked out 8 months for "New Patient" or "Physical" appointments. Here at Bear Medical Primary Care, we spend 30 minutes to an hour with our patients, offering same-day or next-day appointments to restore the patient-physician relationship and improve health.

Less Fragmented Care

The more the primary care doctor is rushed, the more primary care doctor may feel the need to refer to a specialist, even if they have the skills and knowledge to provide modern medical best practices. This leads to a treadmill of "You should see Dr. X about that concern," increasing the number of doctors a person sees, which can lead to miscommunication, medical errors, and repeat testing. How many medical notes can your doctor read in the "8 minutes" they see you?

While direct referral to another provider for profit is illegal under the Anti-Kickback statute (Stark Law), large multi-specialty practices and hospital-based groups make this referral process as easy as possible, maximizing the collection of co-pays and insurance payouts. Specialists are necessary for the "remaining 20%" of medical care and their expertise, but should be used for your benefit, not as a wallet biopsy.

The Affordable Care Act (ObamaCare) introduced a cap on insurance profit margins, but not profit levels. Insurers are supposed to spend 80% of every dollar on care and only 20% on administrative costs. To increase their gross profit, insurers might design the system to encourage patients see more doctors. This becomes a jackpot if the insurance company owns the doctor's office through vertical integration.

Health Insurance is a Business

Insurance is complicated for a reason. It hides the true costs behind complicated lingo, up-selling "silver", "gold", and "platinum" plans using fear tactics, versus "bronze" plans or "HSA" plans with scary deductibles.

Why should you need to know what a PPO vs HMO is? Why is the first question you ask a doctor's office "Are you in-network?" or "Do you accept X insurance?" Insurance companies benefit from frustrating their members into not knowing what they are responsible for, then hiding in bureaucracy and documentation.

Direct Primary Care Vs. Concierge

Direct Primary care shares some similarities with concierge medicine, but has a different philosophy and care model.

• Membership Cost: Concierge doctors often charge more in annual fees than the average DPC doctor. Although the average fee is around $1,800 a year, some concierge practices charge as much as $25,000 annually! DPC fees typically range from $600 to $1,500 per year. In concierge practices, these fees are traditionally paid annually as a lump sum. DPC fees are generally monthly or quarterly.
• Insurance: Concierge doctors accept insurance in addition to the annual fee, they bill insurance for each patient encounter.  They will generally balance bill, making you pay for the remainder of the appointment not covered by your insurance, leading to surprise bills. In Direct Primary Care, insurance is not billed.
• Copays: With concierge, because they accept and bill insurance, they are required to collect copays at each visit.  DPC clinics do not bill insurance, so there are no required copays for each visit.
• Patient panel size. Both concierge and DPC traditionally maintain a patient panel of 600 patients or less. This enables both provider types to have longer, more in-depth appointments with their patients, and a deeper, more satisfying relationship between doctor and patient.
• Insurance Regulation. Because concierge doctors typically bill insurance, they are held to several insurance regulations and documentation requirements. Since DPC does not bill insurance, they are not required to follow these regulations, enabling the physician to document more efficiently and not waste their time with checkbox documentation.
• Office overhead costs. Concierge physicians typically have higher overhead costs, owed in large part to their acceptance of insurance which is required to negotiate insurance contracts, bill insurance, process insurance payments, and then resubmit bills when the insurance fails to pay in a timely fashion. Since DPC physicians do not bill insurance, they do not require staffing and overhead to manage these revenue cycles, resulting in lower overhead. Adapted from https://dpcalliance.org/dpc-vs-concierge/

Save Money by Reexamining Your Health Insurance Plan

Learning the rules of the system allows you to buck the system, saving you cash. Going with a higher deductible plan while being a member of Bear Medical Primary Care might offer significant annual savings.

Your family can now opt for a "lower-tier insurance", HSA/high deductible plan/catastrophic plan with a significant total cost reduction. Here are this year's rates for a theoretical family on the health insurance exchange:

• Bronze Plans for Couple and Dependents: $1600-2000/mo

• Silver Plans for Couple and Dependents: $2000-2500/mo

• Gold Plans for Couple and Dependents: $2500-4000/mo

• Platinum Plans for Couple and Dependents: $4000-6000/mo

• Catastrophic plans: $800/month for Couple and Dependents who are eligible **Based on searching Putnam County NY, Individuals & Families, for Medical Coverage, 2024

  Read more about Health Insurance and Direct Primary Care To run the numbers yourself, see New York Health Plan Marketplace , Connecticut Health Plan Marketplace, or Health Plan Marketplace in Other States

Instead, keep the insurance for the theoretical "worst year," where your appendix bursts, you're in an ICU, you get surgery, and you max out the insurance. In the many better years, save up for that potential worst year with a health savings account (HSA).

You can use your insurance as you regularly would to see any necessary specialists, get medications or covered imaging, or opt to use cash pricing negotiated with local labs, pharmacies, and imaging centers for significant (80%+) discounts.

Benefits of Membership

Once you sign up and become a member, you get unlimited, easy, and quick access to your family doctor. It’s like having a doctor on demand. No long waits for appointments, no hassles, and insurance is NOT required.

We provide comprehensive Primary Care services (acute and chronic) and most Urgent Care services. We offer individualized care for ALL ages, including pediatrics. Our visits are never rushed. We help our patients achieve optimal health, whether it’s by managing chronic medical conditions like diabetes, providing men’s and women’s wellness exams, well-child exams, sick visits, immunizations, health and nutrition coaching sessions, and much more. Our goal is not just to both quickly help you when you are sick but also to get you on track to be as healthy as you can be. Does your current doctor do both for you?

Sign Up Soon

Bear Medical Primary Care provides high-quality services by maintaining a limited number of patients. Enrollment is currently open, but spots are filling up quickly! Join now to secure your membership and experience personalized, accessible healthcare with Bear Medical Primary Care.

Families in Financial Need

We understand that any barrier to healthcare can be devastating, and even the membership fee might be out of reach for some. If you are at your financial limits but are otherwise interested in joining the practice, email Dr. Tocidlowski about signing up for one of our limited "Pay What You Can" plans. This option is especially available if you are or have been a patient before. No judgment, no financial documents necessary.

Continue Reading About Direct Primary Care

Health Insurance's $4.4 Billion Bunker Buster (Forbes, Dave Chase, 2012)