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Direct Patient Contracting

In the College’s 2015 position statement, ACP defines a direct patient contracting practice (DPCP) as 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.

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
An assessment of how direct patient contracting affects access, cost, quality, and other considerations; ethical principles that should apply to all practice types; and 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.
  • TwineHealth Blog — A series of blog posts on things to consider when starting a DPC, marketing a DPC, using social media, etc. as well as free ebooks.
  • 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