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    Is the DPC movement at risk of failing?

    Direct primary care pioneers Qliance and Turntable have closed

     

    “I’ve been skeptical of the movement,” says Berenson, who also practiced primary care for 20 years. “I don’t understand why the same energy (that’s being used for the DPC movement) hasn’t gone into making insurers change their payment methods and their payment amounts.”

     

    Further reading: Can the looming physician shortage be stopped?

     

    Berenson says he does believe DPC is a good concept, but there is not enough data to show its sustainability, and with the closure of Qliance and Turntable—who did not wish to comment on this story—that doubt remains.

    “The sad part is I certainly understand the doctors who want to get off the treadmill, but we already have a shortage of primary care physicians,” he says. “Then we are pulling [physicians] out from the workforce who are catering to healthier people and then that exacerbates the situation we already have.”

    Philip Eskew, DO—founder and CEO of Frontier DPC in Cheyenne, Wyoming—says he has concerns that the DPC movement, “appears to be growing at a linear rather than exponential rate,” attributing most of the growth to smaller, standalone practices. But he notes despite the closure of Qliance and Turntable, “greater than 90% of them appear to remain open.”

    Eskew adds that his greatest concern is “too few family physicians are willing or interested to practice broad scope family medicine, and too few patients are willing or aware that they should be holding their physicians accountable to this higher standard.”

    So, in turn, he notes, patients aren’t making the move to DPC.  

    “Too many patients see direct primary care and think, ‘I already have a cardiologist, endocrinologist and neurologist, but I never see my family physician so I would never use DPC,'” Eskew says.

    Nonetheless, Eskew notes, that DPC is too diverse to fail on a larger scale.

     

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    Bliss agrees and says DPC physicians are still pushing their movement forward in the form of creating their own network without the government’s involvement.

    “That’s where this is going,” she says. “Many flowers are blooming and we’re all just starting to talk to each other.”

     

    *Editor's Note: We have updated this article to clarifiy Philip Eskew's comments.

    joseph-rose-cuyahoga-engagement-photographer-065.jpg
    Rose Schneider Krivich
    Rose is the content specialist for Medical Economics.

    8 Comments

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    • [email protected]
      As an encouragement to anyone who is interested in DPC, we opened a DPC clinic March 2016 with my husband as the solo doctor and we had a waitlist before we were even open a year. We are currently interviewing two new doctors to keep up with the demand. Funding has not been a problem for us because we started as simply as possible and did not take on any debt to open. We were covering our expenses in our first month. It has been a return to real medicine for my husband. If you are interested in DPC and live (or want to live) in the Raleigh area - please look us up. There are so many great doctors who are willing to help new DPC practices and return to "meaningful medicine".
    • [email protected]
      I would also include Harken Health in the practice failures that may signal problems with the DPC model. Harken is a practice model from UnitedHealth that offered "unlimited" primary care as part of the premium paid by patients, which made it similar to the two other DPC offices. I believe that a DPC practice can be viable with a small footprint, but the failure of each of these practices raises an issue about the sustainability of the DPC model. Each of these practices were probably viable at one time, but market forces kept them from being sustainable. It seems that neither Qliance nor Turntable could survive the loss of a major contract. I'd like to know Turntable's financial experience, but Qliance's financials are very surprising. For a DPC model that everyone thought was "proving people wrong," they went through millions of dollars. It may be that patients feel an alliance to small DPC practices that is diminished in a larger footprint. There seems to be a thriving group of DPCs in Kansas, but I think the question remains whether the model is sustainable without being subsidized by the provider, i.e., can a DPC model pay physicians the market rate?
    • [email protected]
      While I have many comments about this article, I do have one major concern. I am highly disappointed with Medical Economics for allowing this writer to publish such grossly inaccurate comments in an effort to change a narrative. Dr. Eskew did not say the comments that Ms. Krivich wrote in her article and by implying he did, is intentionally hurting the DPC movement in addition to showing her lack of integrity as a reporter. May I propose that Medical Economics retract this ill-written article with an apology to Dr. Eskew and the rest of the practicing Direct Primary Care physicians. To other readers, please see his website, DPCFrontier, for his comments on this article.
    • [email protected]
      The DPC movement will benefit from the successful adoption of the DPC model--which requires that physicians understand both the pros and the cons of DPC. I didn't interpret the article as being biased against DPC. The focus was on two DPC-esque practices with significant financial backing that closed, so I expected the article to discuss problems with DPC. I think the take-home for physicians--echoed by the quotes attributed to Dr. Eskew--is that not all physicians/patients/markets are a good fit for DPC. I don't think that detracts from the success that some physicians have had with DPC.
    • [email protected]
      Ms. Benson: Thank you for your comment, but I feel the need to clarify a couple of things. First, the comments are not "grossly inaccurate." A check of Dr. Eskew's website, as you recommend, indicate that the quotes do reflect what he told the author verbatim. Second, our attempt is never to "change the narrative" of a story. All of our authors report what is happening in healthcare today without a "side" or trying to pursuade the reader into one camp or another. A read of Dr. Eskew's commentary shows that his input was in fact robust. As is often the case, we only use some of what sources tell us and not the whole of their comments to tell the story. Our goal was not to intentially hurt the DPC movement - we have no "dog in that fight," so to speak. Our goal is always to provide relevant information to our physician audience. The author has reached out to Dr. Eskew to clarify any misunderstandings regarding his contributions to the story. If a correction is warranted, you can be sure we will make one. We respect the thoughts of all our sources and readers and by no means try to skew them to fit any preconceived narrative. We would be doing a disservice to our readers if that were the case. Keith L. Martin / Editorial Director / Medical Economics / [email protected]
    • [email protected]
      This quote sums up why Qliance failed, "Many of the struggles Bliss continues to see facing DPC—and that she battled with Qliance—stem from the lack of funding primary care receives from the government." The reason DPC is growing is the fact the government is not involved in the payment system! Qliance signed contracts with the state Medicaid and when the Medicaid patients (surprise) didn't utilize their services, the state sent Qliance the bill to claw back the funding. Long-term funding and sexism wasn't the issue. It is the fact that they got in bed with the government and then the government changed the rules. Qliance is not the rule for DPC, they shouldn't be seen as a martyr. They should be seen as foolish. RE: Dr. Berenson's comments about DPC doctors exacerbating the shortage. I ask him to explain why he considers primary care doctors to be indentured servants. The reality is that DPC is only thing keeping primary care physicians in practice longer and the only business model that med students are truly excited about pursuing. The author would be wise to not treat the DPC movement as being a branch of the cronyism that is rampant in the medical system. DPC is a grassroots effort that is making strides each and every day.
    • [email protected]
      I had not read about the state Medicaid funding with Qliance, but that is similar to Turntable's experience. They were initially partnered with the Nevada Co-Op, with their services included as part of those plans. My understanding was that Turntable then received a payment from the plans. When the Nevada Co-Op went out of business, it was a major hit to Turntable. It seems that in their efforts to scale, both Qliance and Turntable ventured into hybrid models that put them at risk. I am absolutely in agreement with your point about the funding. It seems that Qliance would have gone through at least $50 million in ten years. That doesn't seem like a lack of funding. I'm not sure a male-owned company would have received more funding with a $5 million a year burn rate.
    • [email protected]
      Qliance signed their deal with Medicaid, was prepaid, ramped up operations, hired a bunch of docs and then the Medicaid population never showed up. Their model was also a disincentive to docs to perform. There is a huge difference in motivation between an owner of a business and an employee. DPC isn't broken, their models were. If you want to employ doctors, you are competing with hospitals and employer clinics. Neither provide the great care and relationships that are hallmarks of DPC.

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