DPC Savings Examples

What kind of DPC savings have been shown?

Data from Qliance, the second largest direct primary care, practice in the U.S. shows that, compared to patients in standard fee-for-service primary care practices, their patients had:

59% decrease in ER visits
30% decrease in number of days admitted to the hospital
62% decrease in specialty referrals
65% decrease in radiology exams
80% fewer surgeries
115% increase in primary care visits

—yielding a $1,486 savings per patient per year compared to traditional fee-for-service practices.

A two-year analysis of the insurance claims of the 4,000 members of Seattle-based DPC, Qliance, indicated that the cost of care was 19.6% less for Qliance members than for patients seeing a primary care provider under a traditional insurance plan. According to the study, “ER visits, inpatient days, specialty visits, and advanced radiology visits were all lower. The only number that was higher for Qliance patients was the primary care visits. Patient satisfaction was also high.”

Example 1

Patient A was experiencing some belly pain. Unable to get an immediate appointment with his doctor.  His doctor’s office instructed “If he felt like it was bad enough that he needs to be seen today, he should go to the ER or an Urgent Care.”

Patient A went to the ER and was treated. His bill was: As our patient, Adam would have come to our office and paid:
Blood draw charge – $38.14 Blood draw charge – $0
Chemistry – $3524.14 Chemistry – $65
Hematology – $1782.95 Hematology – $29
Urology – $231.79 Urology – $11
Chest x-ray – $490.94 Chest x-ray – $25
CT scan – $10955.13 CT scan – $300
ER Level fee scale – $2700.18 ER Level fee scale – $0
Total $19,723.27 Total $430

You can be seen same day, get stat labs & x-rays and have the doctor that knows you and your history at your side to advocate for your needs.

But you say in the first scenario Adam would have been able to use his insurance.    Yes, BUT there would be an ER co-pay   (typically $150)   Deductible     typically $2700 – $5000       Coinsurance    typically 30% of bill after deductible has been met (30% of $19,723.27 – $5000 equals additional payment of $4,416.98).  Total ER cost for Adam would be close to $10,000 vs $430 at Raleigh DPC.

The payment to the ER would be 10-years of Raleigh DPC Direct membership.

Example 2

Woman cut her finger while chopping veggies. It was 7pm and urgent care was not open, so she went to the ER.

ER bill: As our patient:
Simple Procedure – $332 Simple Procedure – $0
ER Level fee scale – $704 ER Level fee scale – $0
Total $1,036 Total $0

Doctor can meet you after hours at office and help via phone, text and video to determine if immediate care is needed.  If the patient had insurance, the deductible would need to be met and the ER fee would need to be paid.  So the above incident would count towards the deductible but the full cost would be out of pocket for the patient.

Example 3

Patient had cut on head

ER bill : As our patient:
Stitches – $1,330 Stitches – $150
CT scan – $1,978 CT scan – $500
Tetanus – $269 Tetanus – $75
Fee to give tetanus – $100 Fee to give tetanus – $0
ER Level fee scale – $1367 ER Level fee scale – $0
Total $5,044 Total $725

Working with your own doctor with your detailed history, the need for a tetanus shot can be better determined.  There are no additional fees to give a shot and depending on how the injury occurred and symptoms perhaps you could avoid a CT scan.  But these options are available if you and your doctor determine it is needed.

Looking at BCBS 2018 plan details and rates. Patient would have different amounts to pay based on if this incident happened in or out of network, the deductible amount, ER co-pay and co-insurance.  From our research patients would pay: in-network Gold plan: $2,304,  for all other plans in or out of network the full amount would still apply of $5,044

Example 4

We had a patient that endured passing a kidney stone earlier in the year before he was with Raleigh DPC and then passed another while under our care.  Both times he had the same amount of pain, but when under our care he was able to speak with the doctor and give updates and info so that he was able to stay out of the ER.

Patient A went to the ER and was treated. His bill was: As our patient, Adam would have come to our office and paid:
Blood work – $843 Blood work – $16
Urine – $138 Urine – $0
Blood draw – $66 Blood draw – $0
IV bag with meds – $334 IV bag with meds – $100
CT scan – $9,211 CT scan – $400
Total $10,592 Total $516

While on phone with doctor, was able to give real time symptoms and doctor was able to explain what was happening, options, worst care and best case, what to watch for and what to do.  She was available to him throughout the incident and he was more comfortable staying at home and having the advice and information needed.  Looking at all the BCBS plan options the minimum amount the patient would payout after coverage is $2,859.  For the higher deductible plans it can go all the way to the full amount.

The payment to the ER would be 10-years of Raleigh DPC membership.

Get the above examples and exact comparisons to BCBS, check out this pdf file.

Articles of interest:

2/6/2017 from Forbes:  https://www.forbes.com/sites/katherinerestrepo/2017/02/06/states-prove-why-direct-primary-care-should-be-a-key-component-to-any-health-care-reform-plan/#76c8593e419b

12/2/2016 from John Locke Foundation: “A new Direct Primary Care option helped Union County government save more than $1.28 million on health care claims in its first year…” https://www.johnlocke.org/press-release/direct-primary-care-saves-union-county-government-1-28-million-in-first-year/