Dissertations & Theses (Open Access)

Date of Award

8-2020

Degree Type

Dissertation/Thesis

Advisor(s)

Lee Revere

Second Advisor

H Shelton Brown

Third Advisor

Shreela Sharma

Abstract

The Direct Primary Care practice model has been growing in both number of practices and public awareness. However, there has been little academic research about this emerging practice model. This research is aimed to describe the current state of the DPC practice model by examining the services provided, geographic distribution of practices, statistical distribution of membership fees, demographic characteristics of physicians using the model and to determine whether regional pricing variation existed. In addition, differences were analyzed between the patient satisfaction levels in DPC and fee-for-service practices. A dataset was created by visiting the website of all known, non-corporate, DPC practices and gathering data points about the services, pricing structure, and medical providers in the practice. A second dataset was created using the Healthgrades.com patient satisfaction ratings for each DPC physician with seven or more reviews and matching each physician with two fee-for-service physicians, based on medical specialty, gender, age and location. The ratings for each of the eight Healthgrades patient satisfaction questions were classified as high, medium and low and then aggregated by region, physician gender, physician age and urban vs rural practice location. vi Average monthly fees in DPC practices were found to range from $36.00 to $87, depending on patient age. DPC practices were found to offer their patients discounted labs, discounted radiology, direct physician access through personal email, and direct physician cell phone access. More than half of DPC practices offered visits to the patients’ homes and just less than half dispensed discounted prescription medications from their office in states where it was legally permitted. The majority of DPC physicians were board certified in Family Medicine, with the minority certified in Internal Medicine and Pediatrics. A majority of DPC physicians were female, which is quite different from the percentage practicing in fee-for-service practices. This study found that regional variation in DPC monthly fees did exist, with the West and North Eastern regions of the US being more expensive than practices in the South and Midwest. Finally, based on Healthgrades ratings, DPC physicians had higher levels of patient satisfaction than fee-for-service physicians but neither group contained much intragroup variation in ratings.

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