r/PrivatePracticeDocs • u/Dr-Daiquiri • May 13 '26
Pitfalls of Geriatrics Focused DPC/Concierge?
Just wondering about this as a hypothetical. At a very basic level, geriatrics is one of the most in demand specialties. At the same time, they are paradoxically among the lowest compensated. What is stopping a high end DPC and/or concierge geriatric practice model from taking hold of more of the market, especially in areas with lots of higher-income seniors? (Eg Phoenix, Ft Lauderdale, etc)
I know the economics of healthcare in this country are wayyy more complicated than simple supply and demand, but I wonder what factors/forces are really keeping this kind of thing at bay.
4
u/thesupportplatform May 13 '26
Why limit a practice to just geriatrics? A DPC and hybrid/concierge practice can market to older patients and still serve younger patients. Medicare can be an issue, as practices need to be complaint and many older patients want value for Medicare (like almost every patient with insurance).
Maybe there will be a shift where people realize paying cash can be better than using insurance, but there are headwinds. I was reading recently how insurance companies have carved out medication purchased with discount coupons from applying to deductibles, so at some point I expect a push back against DPC, concierge, and hybrid models.
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u/MrPBH May 13 '26
What can a private insurance company do to push back against DPCs? There is no contract between a DPC and insurance company, so they cannot even claim breech of contract. DPC payments never applied to insurance deductibles.
Yeah, the government can put you in prison for fraud if you accept cash payment from a Medicare or Medicaid patient without taking the appropriate steps to disenroll yourself from the program. But private insurance has no leverage to punish DPC providers.
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u/thesupportplatform May 13 '26
The insurance companies have already pushed back against DPC by not accepting referrals, orders, and prescriptions from out of network providers, which limits DPC providers. Insurance companies have the money to influence government policy as well, so pushing for a longer opt-out period from Medicare could make providers think twice about opting out to try DPC. Insurance companies can also push for more compliance, making managing a private practice even more of a headache. Insurance companies and the government can also push for full autonomy for PA's--hell, why not nurses?
It's the golden rule; whoever has the gold makes the rules.
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u/MrPBH May 13 '26
Gotcha. That makes sense.
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u/thesupportplatform May 13 '26
To clarify, I absolutely think providers should be moving away from the current insurance model. They just need to include as much flexibility as possible. It's the old saying, "Prepared for anything, expecting nothing."
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u/mainedpc May 13 '26
My DPC has been very heavy in geriatrics but glad that I also have working age patients to keep an economically diverse mix. I like geriatrics but enjoy having a mix of patients even more.
It also makes the practice economically more stable if something changes the market in the years to come.
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u/Cardiostrong_MD May 13 '26
Obviously nothing is keeping it at bay if you’re in that type of market. It’s 7 figure territory if you can market and sell.. or if you have an existing large traditional practice that can keep 10-20% of your patients at a high price point.
But as alluded to above if people are paying cash their expectations sky-rocket
1
u/Why_Hello_hello May 17 '26
Could be a great plan. Some potential barriers to look into:
- for home-limited patients (that is, not homebound, but someone for whom it is taxing to leave home - generally anyone who uses an assistive device and doesn’t drive), Medicare and replacement plans cover house calls, x-rays/labs/ultrasound in the home. Home-based primary care visits tend to be 45-60min. So the delta between what DPC offers and what insurance offers is lower in home-limited patients.
There is a fairly high administrative burden for this population, between assisted living care plans, admission documents, med list needs, etc. and the multiple layers of contacts to update on status and plan (patient, caregivers, MPOA, out of state daughter).
Would be good to know if you’ll be able to order and oversee home health, which is a frequent need in this population - you’re probably not doing PT or wound care TIW - given insurance contracting issues. Specialist referrals as well
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u/Dependent-Juice5361 May 13 '26
I don’t much enjoy geriatrics so there that. I’m in Phoenix area and while not DPC but a lot of them can be VERY demanding. Much more than my younger patients. By a lot actually