Direct Primary Care (DPC) is an alternative payment model that is proving to be a far better healthcare solution for doctors, patients, and employer groups alike. (See video below). It allows doctors to charge a flat fee per patient for unlimited visits and care (on a monthly, quarterly, or annual basis) — and can be billed to employer groups as part of an employee’s benefits package. This type of arrangement often results in improved health outcomes and substantial cost savings to employer groups. Why? Because easy communication and unlimited access lead to more robust doctor-patient relationships and faster medical intervention. This leads to greater outcomes for the patient, decreased costs for employers, and much-needed improvement to job satisfaction for providers (i.e., coding, aka, “pecking for payment,” is not required under DPC).
Most healthcare regulatory attorneys have little-to-no experience with DPC and are entirely unfamiliar with the specific regulatory laws affecting the ability of providers to practice in this alternative payment model. Both federal and state laws need to be reviewed such as rules prohibiting the corporate practice of medicine and fee-splitting, Medicare Participation and Assignment, the False Claims Act, as well as state self-referral laws. As outside counsel to Nextera, the first DPC service provider in Colorado and one of the largest in the USA, Kathrine has been helping the company and its founder, Dr. Flanagan, navigate these laws from the very beginning.
Management Services Organizations
Because of DPC’s success as a far superior method of delivering primary care, many investors and business people alike are forming Management Service Organizations or MSOs as a way to provide administrative, marketing, compliance and business assistance to DPC providers. Ms. Nicol is continuously giving analysis and skilled drafting to numerous investor business groups helping them create, contract and operate successful MSOs that connect employer groups with DPC providers.
If you’re considering making the transition to DPC, expanding your DPC practice to other geographical areas through affiliates, or are interested in forming a business assisting physicians with the practice of DPC, please contact Nicol Health Law. Ms. Nicol will help you craft not only a suitable DPC program but also the proper legal documentation so you can manage your levels of regulatory and legal risk.
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Guiding healthcare facilities, physician practice groups, and individual practitioners through the maze of legal and compliance regulations.
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