By: Chase Howard
The new autonomous practice regulations allow certain Nurse Practitioners to practice independent of physicians, without supervision, in certain settings. While we’re awaiting further declarations and definitions from the Board of Nursing as to what is including in primary care, there is already an opportunity for autonomous practice nurse practitioners to establish concierge and direct primary care offices.
The concierge practice model and the direct primary care model, however, are still regulated depending on the way patients pay.
The direct primary care (DPC) model gives providers a meaningful alternative to fee-for-service insurance billing, typically by charging patients a monthly, quarterly, or annual fee (i.e., a retainer) that covers all or most primary care services including clinical, laboratory, and consultative services, and care coordination and comprehensive care management. Because a retainer does not cover some services, DPC practices often suggest that patients acquire a high-deductible wraparound policy to cover emergencies. Direct primary care and concierge care are not synonymous. In practices offering concierge care, the patient typically pays a high retainer fee in addition to insurance premiums and other plan obligations (e.g., copays, out-of-pocket expenditures), and the practice continues to bill the patient’s insurance carrier.
Nurse Practitioners need to be aware of insurance restrictions and regulations, as well as any applicable state regulations. In addition, patient’s should have a clear understanding of what is and is not covered under these practice fees/retainers.