12/22/2025
Many people are surprised to learn how primary care clinics are funded. Unlike hospitals, independent (privately owned), primary care clinics are small businesses. We cover our own rent, staff salaries, supplies, insurance, and equipment. Reimbursement from insurance companies often comes months after care is provided.
Primary care is more like a family-owned grocery store than a big hospital system. We only receive pay when we see a patient in office. Office visits are reimbursed at rates set by insurance companies and Medicare, not by the clinic. A provider could charge $10,000 for an office visit, but they will still get reimbursed at the rate the insurance company decides is fair (patients can look at their "explanation of benefits (EOB)" to see those details).
Primary care is also monitored by the 1) the insurance companies the clinic/provider are credentialed with 2) the DEA and 3) CMS (Medicare). If a provider isn’t caring for patients appropriately, insurers/Medicare can end their agreement with the clinic. Also, if the DEA discovers the provider giving controlled substances without seeing the patient every 3 months, the DEA can revoke the privilege to prescribe any medication.
As for Upper County Primary Care:
•Our clinic is stable and paying its bills
•Like many new practices, it takes years before the owner is paid- I’m still waiting but it is very rewarding just seeing my patients healthier
•It takes years for new clinics to break even. UCPC has been open about 1 ½ years, so I feel like we are doing pretty good!
Please let us know if you have any questions! We're here to help!
