Patient Panel Size Will Become the New wRVU
The DPC model has been growing so rapidly that many business players and private equity groups want to get in the game. It seems lucrative and easy. Others have already written about DINOs (DPC In Name Only). DINOs were (and are) a combination of DPC and fee for service third party payments.
With the recent passage of the OBBBA and its new clarifications about DPC, HSAs being used for DPC memberships, etc., I predict a new type of DINO will become more prevalent. It’s already roaming around. This DINO is the one that has an administrative bureaucrat at the top making a hefty salary for “leading” an organization that employs physicians (and other mid-levels) who are paid with a periodic membership fee (DPC-esque). However, these employed providers have little to no autonomy over their schedule, patient panel, staff, pricing, etc. This new DINO looks exciting and refreshing to physicians who are burning out under current oppressive and unrealistic wRVU quotas, “quality” metrics, patient satisfaction scores, and documentation burdens. Moving from all that with a patient panel of ~2,500 to this DINO would seem attractive! What’s the catch? The promise is less patients, less documentation, etc. and no business risk because you’re an employee. That administrative bureaucrat at the top must deal with benefits, marketing, staffing, business taxes, etc. There may even be a signing bonus. Seems like a decent deal at first blush.
I’ve seen the contract from one of these DINOs that I’m describing. It stipulated that any employed doc would have a minimum patient panel of 800 with no cap! An often-quoted number for a typical “full” patient panel for DPC is ~600. Of course, there are DPC practices that have 800 patients, that the physician chose! That detail is quite important; as we all know, one patient is not simply a cookie-cutter of another!
I see a perfect storm: a high number of burned out and morally injured physicians, a federal administration that is promoting DPC and recently passed legislation that is favorable to individuals and employers creating demand for DPC, and a growing group of administrative bureaucrats that want to capitalize on the DPC movement.
Here’s my prediction: patient panel size will become the new wRVU. It’ll start low, normal, or a little above average (800?), but then, over time, with inflation, the need for that administrative bureaucrat to get a new boat, the private equity firm needing to increase returns, etc., the minimum patient panel will be slowly increased like the frog being boiled by slowly turning up the heat. Any employed doc that protests will be gaslit and shamed by pointing out the overwhelming need for primary care in the area, the fact that they are still seeing significantly less patients than their fee for service colleagues, etc.
But it could get even worse! As there is discussion being bandied about Medicaid working with DPC, the administrative bureaucrats could see an easy 20% increase in profit by accepting these patients. We all know that the government will want data: “quality” metrics, documentation just so, etc. Those employed docs will be right back in the burn-out frying pan!
Hey, if you’re burned out and want to switch to DPC, don’t switch to employed DPC with a business guy at the top of the org chart. Instead, connect with the DPC community to do it yourself or join/buy an existing DPC practice (run by physicians). The DPC Summit is just weeks away with lots of great folks and great resources to truly help you.
good thoughts. dpc ( if not done right ) will be a slippery slope right back to where we all came from.
The use of HSA dollars to fund DPC memberships I predict is the beginning of the end for true DPC. By using HSA dollars you essentially are subsidizing the membership which I think will leave it open to more regulation once private equity abuses it and this will be bad for ALL DPC practices not just the DINO’s.