What to Watch for When Signing DPC Contracts With Someone Other than Your Patient

If you’re thinking about signing a DPC contract with someone other than your patient, you need to carefully evaluate the implications of what you’re agreeing to.

There will undoubtedly be many variations of DPC arrangements with contractors, employers, brokers, or scaled-up models.

Listed here are some issues found in these contracts that have come to our attention:

1. A contract with a scaled-up model providing DPC services will require HIPAA compliance, which in an contracted arrangement will be the responsibility of the contracted office including managing any breaches, violations, audits and fines, and training staff annually.
2. Contractor may dictate program design and offerings.
3. Contractor may require use of its own Patient Agreement.
4. Contractor may only allow use of its own internal forms, consent, patient satisfaction evaluations.
5. Requirement for the employed or contracted DPC physician to participate in a required EHR system to collect required data including generation of claims along with associated ICD – 10 codes.
6. Requirement that contractor has the right to terminate an employee of a contracted/employed office for various reasons defined by the contracting entity.
7. Contracted DPC physician will be responsible for providing coverage in case of absence.
8. DPC physician may not be able to terminate a patient without contractor’s or employer’s permission.
9. Contracted DPC office must provide written internal policies and procedures to contractor, ensure its accuracy and implementation, while contractor cannot be held liable for any errors or omissions (ie. fines for an audit).
10. Requirement to participate in marketing without renumeration for time.
11. The Program Agreement may be “amended from time to time” by the contracting entity without prior knowledge or input from the contracted/employed DPC physician.
12. The contractor or employer may define “Scheduled Hours” in any way they want, and an agreement may allow that. This must be defined and controllable by the physician.
13. In contrast to your patients, who pay in advance, a DPC contractor may want to pay you in arrears, one month after services have been rendered.
14. Ensure that you are not expected to provide prescription drugs from your dispensary as part of the monthly fee.
15. Pay attention to the term, ie. two years is too long.
16. Pay attention to the specifics of termination because:
17. Depending on termination clause, a contracted DPC physician could have to provide services for an additional 90 days beyond termination of the agreement, in which case the contracted DPC physician is bearing risk with no financial renumeration.
18. A contracted DPC physician may be required to provide medical records to contractor without payment.
19. Be aware of any restrictive covenants which would preclude a patient from staying with your practice upon termination of the contractor or employer agreement.
20. Any agreement should not be assignable by either party without the written consent of the other.
21. There can be no indemnification of another party for any malpractice action in excess of insurance. The contractor should obtain adequate insurance to protect its own interests.
22. Ensure that compensation is increased if hours in excess of ____ per week are worked.
23. Ensure the panel size is manageable under YOUR expectations and capabilities.
24. Ensure there is full transparency for PMPM fees charged to employer, what part the contractor/TPA is collecting, and what is left should equal any proposed DPC PMPM fee.
25. If employer terminates DPC services with the contractor, with a possible exodus of a significant number of patients from contracted office, ensure there is a clause to ensure payment for lost revenue for a period of time after termination by the employer to ensure ability for contracted/employed DPC physician to rebuild patient panel. This would also apply if contractor terminated contract with DPC office.  A contracted arrangement may be prohibitive to organic growth of the contracted DPC office; termination of the agreement could financially damage the DPC contracted physician/office particularly if organic growth was limited by contracted arrangement.
26. Contractor/DPC employer should agree to payment to the contracted/employed DPC physician of a certain percentage of the PMPM fee charged to employer for employee DPC services.
27. Contractor/DPC employer should agree to be 100% transparent of fees charged to employer group for DPC services and provide that contract for review annually to contracted/employed DPC physician.
28. Be sure that the agreement complies with state law. Some states, for example MO and possibly NE, require DPC agreements to be between the patient and physician.

Recognize many of the points in an agreement you’re thinking of signing?  Here are some words of caution from a noted health care attorney after reviewing a contract containing a number of the above pitfalls: