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Direct Primary Care: A Legal and Regulatory Review of an Emerging Practice Model

January 1, 2015
By Philip M. Eskew

Direct Primary Care (“DPC”) practices are a type of retainer practice where physicians directly charge patients a periodic fee and avoid any third party fee for service payments.

stethoscope and insurance docs

Direct Primary Care (“DPC”) practices are a type of retainer practice where physicians directly charge patients a periodic fee and avoid any third party fee for service payments. These physicians have been small and overlooked group for many years, but the recent growth of the model demands attention. Previously tacit insurance commissioners have taken notice. Laws enacted by six state legislatures and the Affordable Care Act provides a background from which a legal framework can be developed. This article will articulate “business of insurance” concerns encountered by DPC physicians including recommended contractual provisions to minimize this risk, compare state laws written chiefly to address this concern, consider the DPC provisions of the Affordable Care Act, and briefly consider tax and scope of practice policy implications of the DPC model.

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Health Care