How to Set Pricing For Your DPC Practice

There are lots of options: flat rate, age tiers, couple/family plans, annual discounts, or some combination thereof. Some practices charge a one-time enrollment fee. Others have no initial fee but charge for re-enrollment. Some practices charge a low per-office visit (something that my be required depending on your state regulations).

Some practices also do access/quality tiering: for instance, a Premium plan that includes guaranteed same-day scheduling, more comprehensive preventative testing, home visits, increased personalization, etc. This is an effective way to do some price discrimimation: if there is a wealthy subpopulation in your area that's willing to pay extra for preventative care, let them! For an example of a practice that offers a low-price DPC membership and a premier concierge offering, check out Family First Health Center. However, you should make it clear in your marketing materials that your members are paying for care, not access — otherwise, you could be classified as an insurance plan by a zealous insurance commissioner.

Click around the DPC Frontier mapper to see what other people are doing.

It may take some time to figure out what's best for your practice based on your patient panel makeup. Some docs refuse to accept back any patient who disenrolled or missed a payment. Others require back-payment of all membership fees missed during a gap in membership. Others charge a one-off re-enrollment fee. This should be at least twice your monthly fee to discourage on-again-off-again behavior.

If you do in-office dispensing, decide whether to mark up dispensed meds. You can mark up meds quite a bit and still offer your patients a great deal compared to the pharmacy prices. It could be a good source of additional revenue for your practice. That said, offering "wholesale prices" on drugs is often a compelling part of your sales pitch.

Just as for medications, it is possible to mark up the cost of lab work while still offering your patients a great deal.

For pathology services, some states have laws against price markup by physicians; see the "anti-markup" states listed here. Still more states require disclosure to patients of the actual cost charged by the lab (see "disclosure" states here). You should probably be doing this anyway for the sake of price transparency.

Some practices charge a low per-visit fee to keep visit demand manageable. If you have a problem with excessive unnecessary visits, consider this. According to DPC Frontier, this fee should be lower than your monthly fee if you wish to qualify as DPC in most states.

Some practices still do one-off visits with non-member patients, either for additional revenue or as a way to attract new members. During the visit, describe DPC to the patient and offer to credit the cost of the current visit towards their enrollment fee/first monthly fee. This can be a successful marketing tool.

Some practices do this to mitigate the headache of billing management. For larger expenses, patients are more likely to pay by check or bank transfer, which means you lose less money to credit card fees. Plus you don't have to track down patients whose card failed on a monthly basis.

Consider whether to bill in advance or in arrears. Billing in arrears (at the end of a month of membership) may seem unintuitive, but it puts you on more solid legal ground. Specifically, it is an excellent thing to point to if anyone (an insurance commisioner, for instance) accuses you of being an insurance plan. Billing in arrears also helps qualify you as an eligible expense for patients paying with an HRA or FSA. Note that DPC memberships shouldn't be paid from an HSA (Health Savings Account) — see the DPC Frontier discussion here. Some docs accept payment from HSAs without retribution; this issue has yet to be litigated.