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Direct Patient Contracting

Direct patient contracting (DPC) is any practice that directly contracts with patients to pay out-of-pocket for some or all of the services provided by the practice, in lieu of or in addition to traditional insurance arrangements, and/or charges an administrative fee to patients, sometimes called a retainer or concierge fee, often in return for a promise of more personalized and accessible care.

Direct patient contracting encompasses a number of different models and terms including concierge, boutique, cash-only, retainer, and direct primary care or specialty care practices. The models differ depending on the amount of the fees charged, what services are covered by the fees, and whether the practice bills insurance.

ACP Information

Assessing the Patient Care Implications of “Concierge” and Other Direct Patient Contracting Practices: A Policy Position Paper From the American College of Physicians
This 2015 position paper assesses how DPC affects access, cost, quality, and other considerations. It also discusses ethical principles that should apply to all practice types and proposed policies to mitigate any adverse effect on underserved patients.

Direct Primary Care

Direct Primary Care (DPC) is a form of direct patient contracting that focuses specifically on a billing and payment arrangement between a patient and clinician for primary care services. Typically, these relationships involve monthly fees and/or payments for primary care visits services. Third-party payers (i.e., traditional health insurance plans) are typically not a part of the payments or billing under DPC. As a supplement to the DPC services, patients often have either a high-deductible health plan or a health savings account (pre-tax account for health care needs) that can be used to cover medical needs outside of the DPC relationship.

Direct Primary Care Resources

  • Direct Primary Care Coalition — A coalition supporting the direct primary care payment approach with advocacy information and state and federal legislation.
  • DPC Frontier — A compilation of numerous resources including pertinent regulations (federal, state, Medicare and Medicaid, etc.), legislation (state and federal), how to start a DPC practice, etc.
  • Direct Primary Care Journal — News stories, data, and business insights into direct primary care.
  • AAFP Direct Primary Care Resources — Resources from the American Academy of Family Physicians on direct primary care including a toolkit for purchase.

Direct Primary Care Articles