Are Direct Primary Care and Concierge Services Increasing and Are They Feasible For Providers?

By: Pearl Walia

As payer disputes continue to rise and burden healthcare provider operations, physicians are increasingly looking for ways to limit their interactions with payers. Direct primary care (DPC) and concierge care have emerged as alternative practice models. But are these models feasible for practices in the long run? 

 

What is Direct Primary Care? 

 

Direct primary care (DPC) is a subscription-based model for delivering primary care without accepting insurance. The practice generates income from a flat monthly fee paid by patients, focusing on routine, affordable, and preventative care without the complexities of insurance. Services often include physical exams and wellness checkups, routine lab tests, vaccinations, minor injury care, and treatment for infections or the flu. Because patient volume is lower, patients often receive same-day or next-day appointments, longer visits, and direct access to their doctor by phone, email, or video call. DPC allows providers to focus more on personalized patient care and less on the administrative burden of insurance billing. It’s important to note, however, that DPC does not replace insurance for services such as emergency care, specialist visits, or hospitalizations. DPC practices often serve around 2,000 patients.

 

What is Concierge Medicine?

 

Concierge Medicine similarly offers greater access and a closer relationship between patient and physician. Patients pay a monthly or annual retainer fee, but practices under this model still bill insurance for office visits, labs, and certain procedures, ultimately adding back in visit-length constraints, billing complexity, and documentation requirements. This gives concierge practices two revenue streams: membership fees and insurance reimbursement. It also allows physicians to coordinate with hospitals, specialists, and other providers within the patient’s existing healthcare network. Concierge practices typically range from 300 to 600 patients.

 

What Patient Population Do Concierge and DPC Practices Serve? 

 

Both models primarily attract patients who need more frequent visits or direct access to their doctor without navigating a referral chain or insurance approval process. Families with young children, for example, tend to visit the doctor more often due to routine check-ups, sick visits and follow-up care. Busy adults who need to reach their doctor quickly are another common audience. Patients managing chronic conditions such as high blood pressure, diabetites, asthma, or thyroid disease also benefit from these models, since they require regular check-ins and cannot accommodate constant scheduling conflicts. 

 

How are these New Models Shaping the Future of Medical Practices? 

 

According to research from the Johns Hopkins Carey Business School, Oregon Health & Science University, and Harvard Medical School, the number of DPC and concierge practices in the United States grew by 83.1% between 2018 to 2023, a clear sign of the widespread adoption of membership-based healthcare models. This growth is driven largely by physicians moving away from traditional primary care, which often brings burnout, heavy workloads, and significant administrative burden from insurance paperwork. 

 

Pros of Switching to a DPC or Concierge Model Smaller patient volume  Stronger patient relationships More focus on patient care, less on administration  Reduced interaction with insurers Minimal to no insurance battles Higher revenue through membership fees

Cons of Switching to a DPC or Concierge Model Fewer patients (due to affordability concerns)  Building a patient base from the scratch, with the risk of losing existing patients Complications of operating outside traditional payment models High overhead costs

 

Considering a Switch to DPC or Concierge Medicine? What Providers Should Know

 

• Compliance with Pricing and Regulatory Requirements: Before switching models, providers should ensure compliance with federal and state laws on fee-splitting and anti-kickback/anti-referral statutes, as well as regulations governing retainer fees and medical memberships, which vary by jurisdiction. 
• Structuring Contracts and Marketing Materials: Because these models offer more limited scope of included services, it’s important to clearly outline services, fees, and limitations in contracts and marketing materials, in compliance with advertising and privacy laws. 
• Determining Whether to Accept Commercial Insurance: Concierge practices must decide whether to accept commercial insurance alongside membership fees or remain fully independent, as with DPC. This decision will shape reimbursement policies and billing protocols. 
• Ensuring Data and Privacy Compliance: Given the 24/7 access to physicians and the increase in in-person and remote communication, practices must comply with HIPAA’s security and privacy requirements, as well as any other applicable telemedicine regulations. Practices using AI tools such as chatbots to support patient communication must also have policies in place to ensure responsible AI use and protect patient privacy. 

 

How Does a Practice Know if DPC or Concierge Medicine is Right for Them? 

 

Concierge medicine and DPC offer physicians greater independence and a stronger focus on patient care compared to traditional primary care. However, this model isn’t for every provider. Despite the autonomy it offers, it significantly limits patient volume due to affordability constraints and requires careful attention to regulatory structuring and the challenge of building a practice from the ground up. Like any business venture, starting a DPC or concierge practice involves upfront costs and financial risk. Providers are encouraged to consult an experienced healthcare attorney to evaluate their current practice, long-term goals, and whether this model fits their individual needs. 

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice; it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please get in touch with me using the contact information listed above.

All information and references to laws, rules, regulations, and advisory opinions were accurate as of this time, but laws are constantly evolving. Please get in touch with me to ensure that the law governing your business is up to date. Thank you.