The System is Here to Help Doctors

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I mentioned this article in a recent post, but didn’t get into it. Now, I will because it just amazes me. You see, I have been around the block in medicine for over three decades, and I have seen the same old playbook. Often, career administrators or doctors dressed as administrators come out of the woodwork with some new bogus plan to save physicians. Remember, ACOs (Accountable Care Organizations) or Pay-for-Performance Models?

How about some others:

  • Comprehensive Primary Care (CPC) Initiative (2012) and CPC+ (2017)
  • Primary Care First (PCF) Model (2021–2025)
  • Making Care Primary (MCP) Model (announced 2023, terminated 2025)
  • MACRA / MIPS (Merit-based Incentive Payment System, 2015 onward)
  • Meaningful Use / EHR incentives (HITECH Act, 2009)

It all fails, but it never stops those in the system from coming up with something new.

The new angle is to say that Concierge Care is great, so we will copy it. This article, called Concierge Medicine Was Built For The Few. Here’s How To Open It To The Many, is a perfect example of someone trying to buff their resume with some retread concept. This one comes from Eve Cunningham, MD, MBA, who is a career admin who dabbles in clinical care.

In the article, she calls DPC the cousin of Concierge Care, and so she lumps us together. Okay, whatever, but at least do a little research. She goes on to extoll all the benefits of what we do:

Patients are drawn to concierge care because it addresses two of the most persistent failures in modern primary care: limited time with clinicians and fragmented relationships. The model delivers predictable, same-day access and longer visits that allow clinicians to listen and problem-solve. It also offers direct communication with the care team and more hands-on coordination after hospital or specialist visits. Together, these features reduce patient anxiety, improve chronic disease management and create a more seamless experience. These are not luxury extras. They are the core components of high-quality primary care. Making them more widely available would shift care from reactive crisis management to proactive prevention and improve outcomes, especially for older and more complex patients.

Great. But she has another idea:

Advanced Primary Care Management (APCM) is Medicare’s effort to address these gaps at scale. Launched January 2025 (HCPCS G0556–G0558), APCM pays practices a per-patient, per-month fee for a defined bundle of services: 24/7 access, patient-centered care plans, care-transition management, enhanced asynchronous communications, population-level management and quality reporting. The codes are tiered for complexity, with higher payments for patients who have multiple chronic conditions and for low-income seniors. Importantly, APCM removes the burdensome time-tracking requirements that limited adoption of prior care-management codes and introduces predictable, subscription-like revenue without requiring patients to pay a retainer.

Yup, it’s deja vu all over again. They actually think this will work in the system.

In short, APCM makes it financially feasible for practices to give patients the time and continuity of concierge care while compensating the clinic and system for the work required to do so equitably.

I now refer to the video that started this post and I believe we can already add Advanced Primary Care Management (APCM) to the list on top as well.

If you want to do Direct Primary Care, then do Direct Primary Care. Maybe Dr. Cunningham should leave the administrator work or the system and try it. She may enjoy it.

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About Douglas Farrago, MD

Dr. Farrago is a retired family physician based in Forest, Virginia. Since 2021, he has run DPCnews.com, a leading resource for the Direct Primary Care (DPC) movement. He is the author of three best-selling books on Direct Primary Care: The Official Guide to Starting Your Own Direct Primary Care Practice The Direct Primary Care Doctor’s Daily Motivational Journal Slowing the Churn in Direct Primary Care (While Also Keeping Your Sanity) In 2016, Dr. Farrago conceived the idea for the Direct Primary Care Alliance and co-founded the organization alongside other pioneering DPC physicians. He is widely recognized as a leading expert in the DPC model and frequently lectures to medical students, residents, and practicing physicians on how to successfully start and run their own DPC practices.Dr. Farrago sold his Direct Primary Care practice in October 2020 but continues to receive care there as a patient.