In my article, “Why Adding Non-DPC Services is a Great Way to Build or Grow Your DPC Practice” which was part 1 of this 3 part series, I discussed the advantages of adding non-DPC services to your DPC practice, which include having additional revenue streams (avoiding moonlighting or hybrid practice which many DPC docs reluctantly do when starting out), being able to limit your panel size, building your brand, and keeping things interesting. If that sounds appealing, then the next question becomes, which non-DPC services can I add and what are the logistics of doing this? Fortunately, there are many options, and I will share with you some excellent examples of what our DPC colleagues are doing.
While there are many options, you should choose those that you are most comfortable with, and those that fit with your practice’s brand. If you are DO trained, then adding osteopathic manipulation as non-DPC service makes sense. If you are not comfortable selling products, then don’t do this. That said, you should not fear trying something new. There are many courses you can take to learn procedures and skills that don’t require board certification.
There are many ways to categorize services you can add to your DPC. The following is an attempt to do so for purposes of discussion, but you will note the categories are far from perfect and there is some definite overlap.
Extensions of Primary Care: These are services that most primary care physicians might do normally as part of a regular practice but could allow charging an extra fee. They require little or no extra training. In addition, these are services that could be done once or for a limited number of times for non-member patients as a cash/fee for service, but could also be included at no extra charge for current DPC members.
Department of Transportation (DOT) exams- Commercial drivers are required to get DOT physicals, and physicians must be certified to do this. Since insurance-based PCP’s may not be certified to do this or it might simply take too long to get an appointment with them, drivers may be willing to pay cash for DOT exams. Dr. Adriana Raus of Michigan’s Family Doc Directperforms DOT physicals as well as immigration physicals as part of her DPC.
Sports Physicals- similarly, sports physicals are often required by student athletes in order to participate in sports, and parents may be willing to pay cash to get this done efficiently. Internal Medicine Drs. Brian and Kim Erdmann at Priority Medical Partnersoffer many services, including sports physicals either as a single visit fee for service option or included with their DPC membership.
Obesity and Weight Management- There are so many options here, including medical weight loss, nutrition, and coaching. Family Physician Dr. Kara Sjogren is also a Diplomate of the American Board of Obesity Medicine (though this is not required) and includes her supervised medical weight loss program as part of her DPC membership at Impact Health DPC, but this can also be paid for separately by non-members.
Alternative Medicine: These are services that are not normally done by primary care physicians, and in many cases are not covered by most insurances, so there is usually the expectation by patients of a separate fee, including for members. Many of these services require some additional training and/or certification. Since integrative medicine includes both allopathic and alternative medical treatments, offering alternative medicine non-DPC services can help brand practices as treating “the whole patient.” In addition to osteopathic manipulation, other alternative medicine services include:
Acupuncture- An excellent example of non-DPC services helping with branding is Internist and rheumatologist Dr. Yousef Zarbalian who performs acupuncture for both members and non-members at East West Rheumatology.
IV therapy- There are many types of IV therapies that can be added as non-DPC services. Family physician Dr. Matthew Abinante offers IV hydration therapy at Elevated Health. DPC members pay a little extra for these services, and non-members pay about double.
Integrative medicine- Integrative medicine means many things and can include a variety of non-DPC services. Family physician Dr. Ben Hagopian of Maine Integrative Family Care did two integrative medicine fellowships, including one Dr. Andrew Weil, and incorporates this with all his DPC members. However, non-members can have a one-time consultation and one follow up for a fee. (I am guessing his conversion rate from his consultations to joining his DPC practice is fairly high).
New or non-covered services: In addition to alternative medicine, there are some traditional services not typically done by primary care physicians that are generally not covered, in some cases because they are new.
Aesthetics- This had been traditionally done by dermatologists and plastic surgeons, but PCP’s are finding they can also add these non-DPC services for members and non-members. DirectMD in Austin not only has integrative medicine service, but they also do aesthetics including injectables like Botox and have a Medspa with facials and lasers. DPC docs interested in aesthetics should be cautious about purchasing big fancy machines (I will explain my difficulties with this in Part 3 of this series).
Regenerative Medicine-Many DPC docs, Family Physicians in particular, have incorporated sports medicine into their regular DPC practice. Regenerative medicine is an extension of this, treating painful tendons, joints, and ligaments of athletes and arthritics. Regenerative Medicine utilizes the natural healing mechanisms of the body to repair injuries, including prolotherapy, platelet-rich plasma (PRP) and even stem cells. Yorba Linda Family Physician Dr. Adam Schulte, who also completed a Fellowship in Primary Care Sports Medicine, has incorporated multiple non-DPC services into his DPC The Drop In Doc, including regenerative medicine.
Medical cannabis- Medical marijuana is now legal in 36 states (and counting) and the District of Columbia and requires certification by a registered provider. Most certifying providers who promote this service are not physicians, but rather nurse practitioners, dentists and even podiatrists. These clinics are generally cash only, paper pushers that make no specific recommendations to patients regarding treatment. While insurance-based physicians can do this (though most have no desire), it would be difficult to charge a large cash fee or a premium for medical cannabis certification, as it would likely violate insurance contracts (you probably can’t treat back pain patients with narcotics and bill insurance but recommend cannabis and ask for cash). Since DPC docs take insurance, they don’t have this issue, and I have found that many patients are willing to pay a premium to get seen by a real doctor who will answer their questions.
Products– Medical school did not train physicians for business, let alone retail sales. In addition, retail sales can make many physicians uncomfortable (myself included) because selling is not in our nature. (We didn’t go to medical school and residency to sell things). However medical related products are a health related non-DPC service that can work well in many practices. They are often a good extension of other related non-DPC services. In addition, patients are purchasing these products anyway, and many would prefer to get it from their physicians.
Vitamins and Supplements- For those doing discount prescriptions, vitamins or supplements may be a natural extension of your practice. This can also work well for those doing weight management or integrative medicine. Kansas Family Physician Dr. Mohammad Ghassemi’s Midwest Health Group DPC incorporates nutritional counselling and medical fitness, and also offers patients supplements and intermittent fasting packages through NuMedica. Vitamins and supplements can be purchased wholesale and sold retail, or handled completely online by the company, where the referring provider gets a commission for the referral.
CBD- While I never though in a million years that I would be doing retail sales, I started offering hemp based CBD to patients in my clinic because I was recommending this as part of my medical cannabis consultations, the cost of cannabis CBD in the dispensaries was very expensive, and while CBD can be purchased everywhere it is not regulated by the FDA, and thus finding good, high quality, 3rd party verified hemp based CBD is not that easy for many patients.
Cosmetics- Family Physician and DPC legend Dr. Julie Gunther offers serval aesthetic procedures at SparkMD DPC. The two skin care lines she offers is an excellent extension of her non-DPC services. Louisiana Family Physician Dr. Dana Ewing Mays has a traditional DPC at Yapha MD, but also offers her patients skin care products from Neora.
There are several things to consider if you decide to offer non-DPC services as part of your DPC. This is especially true if you are just starting your DPC and looking at EMR’s. First, you want to think about registration of non-DPC members in your practices. Most EMR’s used by DPC’s have options for multiple membership types. You should also consider whether you want to generate an invoice (superbill) for patients to submit to insurance. While this is controversial for DPC members, it can work quite well for non-DPC services of which some may be reimbursable. Some EMR’s allow for easy creation of invoices. If you are selling products, then you have figure out how to collect and pay sales tax, and some EMR’s which do billing allow for this. Finally, you need to consider pricing of your non-DPC services for members and non-members. Discounts for members is usually a good business practice. In addition, since many services are conducive to conversion, allowing payment for a non-DPC service that is covered in your DPC to count toward membership should the patient decide to join your practice can be a savvy way to enhance conversion.
Dr. Matthew Mintz is an Internal Medicine and Primary Care physician, whose concierge-style DPC offers non-DPC services including Spravato (nasal esketamine), medical cannabis, and TruSculpt3D. Dr. Mintz’ website is www.drmintz.com and medical cannabis site (different for legal reasons) is www.mdcannabisdoc.com.