What about DINOs?

What is the difference between Forest DPC and hybrid DPC/third party payer practices (DINOs)?

Forest DPC is the original Direct Primary Care practice in the Forest/Lynchburg area. We are strictly a DPC clinic. A hybrid office, which claims to provide Direct Primary Care while somehow still offering traditional third party payer (insurance and government) programs, is caught between two worlds. They are DINOs (DPC In Name Only)! They are merely dabbling in DPC. It’s not surprising that everyone is trying to get into DPC (urgent cares, large Family Medicine groups, hospitals, health care systems) without actually being pure DPC. Since 2012 there’s been a 90% success rate of DPC clinics. When a DPC clinic fails, it’s usually a hybrid practice!

Why do DINOs fail?

DINOs don’t have a true identity. Are they traditional third party payer practices? Are they DPC? No one knows; they don’t even know. Their staff are even more confused than you.

You can’t dabble in DPC; it’s all or nothing. Many hybrids want to dabble in DPC because it’s trending, and they want to capitalize on this. But it’s not about money. DPC is about a relationship between doctor and patient without interference from third parties; it’s about doing medicine the right way.

In hybrid practices, you do not and will not get the true DPC experience!

Patient panels. The providers (physician assistants, nurse practitioners, and physicians) still have LARGE panels. Their main book of business is from third party payers. You are one in ~2,500 patients per provider. They still get calls from all those third party payer patients, but somehow you, as a DPC patient, are called back first?! Somehow, you as a DPC patient, are promised to have preferential treatment?! Not only does this sound like a marketing gimmick, I’ve personally experienced one of these gimmicks! Before taking the helm at Forest DPC, a prior employer of Dr. Dan’s provided a “DPC benefit” with a large local Family Practice group. The first clinic in that group that he tried to join with this “DPC benefit” took weeks to get back to him after multiple reminder calls on his part, only to finally learn they weren’t taking any new patients almost a month later! At his second choice clinic in the group, the soonest physical he was able to book was almost half a year out from his request! Yet his prior employer was disappointed at how few employees were taking advantage of the “DPC benefit”. Hard to imagine how much longer it would’ve been to schedule an appointment if the majority of his colleagues had taken advantage of this “DPC benefit”!

Clinic experience. You still have a waiting room full of patients (some sick, and no special waiting area for DPC patients, because that’d be AWKWARD). You’ll still have to check in with the same procedures, forms, etc. then get the same third party payer experience. Dr. Dan certainly did.

Lack of continuity; variable training. These hybrids have larger office staffs that can’t possibly know you personally. You don’t always get to see your doctor, because your doctor may be booked with third party payer patients that day. Also, your doctor, may not be a doctor at all! You may be paying for a visit with a midlevel provider, that also may not know you. “When Your Doctor Isn’t a Doctor” is an eye opening article about mid level providers and the rise of urgent cares; worth a read. Lastly, your doctor will not be on call for you, at least not most of the time.

Carve outs. Watch out! You’ll have (and need) a manual to understand exactly which services are covered in a DINO hybrid under their DPC benefit and which are being charged to a third party instead. Both can happen in the same visit! One of the most common areas are outpatient procedures. Need a splinter removed? No problem, your DPC fee covers that. Need a joint injection or skin biopsy? That’ll go to your third party coverage! Why?! Follow the money – outpatient procedures are highly compensated by third parties and often take minimal time and overhead cost. The DINO hybrid makes more that way, but it costs you, the patient, more as that procedure cost goes to your (possibly high) deductible.

Some other important differences:

Contract. We don’t require a yearly contract. If you are not satisfied with your experience at Forest DPC, or if you have a change of circumstances, we want you to be able to make a change. All we require is a thirty day notice.

Access and continuity. At Forest DPC we get most patients in for acute appointments the same day, and certainly within 24 hours, with your board-certified, broadly trained, experienced Family Medicine physician. We can answer texts and e-mails within the day.

All are welcome! At Forest DPC we accept Medicare and Medicaid patients because we opted out of those third party programs. In most hybrid models, you can’t be part of their DPC benefit if you have either of these benefits because they are still contractually obligated to provide services under those benefits; they cannot double bill you, or your employer, for DPC services, and then Medicare/Medicaid for the same services.

Why does Forest DPC cost a little more than some hybrids?

Just because you call an apple an orange doesn’t mean it is an orange! Any primary care practice can claim to be DPC, but that doesn’t mean it really is! Forest DPC has worked hard to streamline its practice and find the most competitive pricing for our patients. Forest DPC has transparent pricing, and avoids “nickel-ing and dime-ing” patients. DINOs often lowball their prices. To compensate, they must have larger patient volumes and end up with the same “herding cattle” third party payer, fee for service experience. It becomes bait and switch!

Dr. Doug Farrago, prior owner of Forest DPC, and a trailblazer for the DPC movement, recently wrote the following opinion piece about hybrid practices for DPCNews.com. Although his intended audience is physicians considering DPC, I think it helpful for all trying to understand pure DPC and hybrids.

The Great Pretender: Syphilis or DINOs (Direct Primary Care In Name Only)?

Experience pure DPC!

Call us today to schedule your meet-and-greet to learn how Forest DPC, a pure DPC practice, can provide affordable, accessible, comprehensive and personal primary healthcare for you, your family, or your business or nonprofit. (434) 616-2455