A Nurse Practitioner Opened This New Hampshire DPC Clinic. A Maine Colleague Says 80% of His Patients Have No Insurance.

Practice Spotlight by DPC Insider — Practice Desk
#new-hampshire#nurse-practitioners#uninsured#rural-dpc#maine
Sources: Direct primary care clinics offer alternative payment model · Origins DPC PLLC — Pricing Details · AAFP — Direct Primary Care Model for Family Physicians · New Hampshire RSA 326-B:11, Scope of Practice and Authority; Advanced Practice Registered Nurse · New England Direct Primary Care Alliance

Origins DPC publishes its membership prices on one page. Ages 3 to 25 pay $50 a month. Ages 26 to 44 pay $75. Ages 45 and over pay $100, and a family of four or more stops at $300. There’s no enrollment fee, and members commit to three months.

The clinic sits on East Main Street in Warner, New Hampshire. Sarah Mullins, a family nurse practitioner, opened it two years ago after 12 years with Concord Hospital, the Concord Monitor reported this week. She founded it. That single fact changes more about the practice than the fee schedule does.

The prices land exactly where the national data says they should

The AAFP puts monthly DPC membership fees between $50 and $100 and average panel size at roughly 413 patients. Origins uses both ends of that band rather than picking a point inside it, sorted by age, with the cheapest tier going to the youngest patients and the most expensive to the group most likely to need chronic disease management.

Costs vary by practice and by location, and a fee page is not a promise about what any given patient will spend. What’s interesting is the rest of the price list.

Full-time college students pay $300 per semester regardless of age, which the practice ties to New England College and Colby-Sawyer being nearby. Campers and travelers pay $300 for a seasonal membership running Memorial Day weekend through Columbus Day weekend. A non-member walking in for a Department of Transportation physical pays $125, pass or fail.

Each of those is a product, priced for who actually turns up near a small New England town: students for two semesters, seasonal visitors for one summer, and commercial drivers who need a form signed before a deadline. Origins puts a flat price on each of them, on the same public page as its memberships.

New Hampshire law lets an APRN prescribe and dispense on one license

New Hampshire licenses advanced practice registered nurses under RSA 326-B. Section 326-B:11, III gives an APRN “plenary authority to possess, compound, prescribe, administer, and dispense and distribute to clients controlled and non-controlled drugs within the scope of the APRN’s practice.”

Read that clause slowly if you’re an AP thinking about ownership. Prescribing and dispensing sit in the same sentence, under the same authority, and the scope section that defines APRN practice in that chapter doesn’t hang either one on a physician agreement. For a solo cash practice, that’s the difference between routing every prescription through somebody else’s signature and running the whole loop yourself.

Nurse practitioner practice and prescribing authority vary by state, and anyone building on this needs to check their own. New Hampshire’s text is unusually direct about it.

Mullins also does the work that dispensing authority doesn’t cover. She told the Monitor she’s built relationships with imaging facilities and independent labs to get her patients rates she can compare against what their insurance would charge, and that insurance rates tend to run much higher.

The patients nobody is counting

The number that should stop you is in the second half of the Monitor’s piece.

Dr. Jack Forbush started his DPC practice in Maine 14 years ago, the Monitor reports, and he co-founded the New England Direct Primary Care Alliance. He told the paper that about 80% of his patients don’t have insurance.

“These are people that either didn’t go see a doctor or went and had to pay an exorbitant amount of fee for fairly routine care, and therefore they wouldn’t go,” Forbush said. “Now they have a very reasonable price point to have a family doctor consistently.”

Employer adoption and HSA eligibility are the easy things to count. Both are real, and both describe somebody who already has coverage and is deciding how to spend it. Forbush is describing a different buyer entirely. For his panel, a monthly membership competes with not going at all.

That’s a different growth story than the one in the trend reports, and it’s much harder to measure, because uninsured patients don’t show up in a benefits administrator’s enrollment file.

The limit Origins states out loud

Origins doesn’t oversell this, and the honesty is worth repeating.

Origins says on its own homepage that DPC is not insurance and that it still encourages coverage for emergencies, hospitalizations, and catastrophic events. The AAFP reports the same pattern: because some services fall outside a retainer, DPC practices often suggest patients carry a high-deductible wrap-around policy.

So for an uninsured patient in Warner, $50 to $100 a month buys a primary care relationship. It does not buy a hospital stay. The model closes the gap where most of the missed care happens, which is routine and preventive and chronic, and it leaves the expensive tail open. Anyone writing about DPC as an answer to uninsurance has to hold both halves of that at once.

Mullins spent her hospital years in appointments she describes as rushed. Now she can spend at least an hour.

“I think that really changes the dynamic of that provider-patient relationship, and that’s what I really appreciate, is that you really get to know the whole person, get to work with them on many different areas,” she said. “I like that we don’t have to feel like we have to refer things out because we have the time to work on those things.”