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Ep. 85 Trump’s 6/24 Executive Order: A Turning Point for Direct Primary Care?

President Trump’s June 24, 2019 Executive Order on health care transparency contains a key provision regarding direct primary care.  We have the pleasure of having back on the show Dr. Lee Gross.  Dr. Gross and colleagues in the DPC movements were instrumental in getting the White House to clarify a prior ambiguity regarding how direct primary care membership fees ought to be considered from a tax standpoint.  Dr. Gross will be telling us about this effort and about the implications of that change for the growth of the direct care movement.

Dr. Gross is a family physician in North Port, FL.  He is a pioneer and a leader in the DPC movement.  He is a health care consultant to physician practices, medical organizations, insurance groups, hospitals and private businesses. He founded and serves as President of the Docs 4 Patient Care Foundation and he is chairman of a new lobbying organization called DPC Action.

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Why the Trump Executive Order Making Healthcare More Transparent Is A Big Deal

On June 24, President Trump signed an executive order, intended to return health care decision-making back to patients. It requires hospitals to publicly disclose how much patients will actually pay for services that they receive. It also gives patients the ability to use funds in tax preferred accounts such as HSAs (health savings accounts) to shop for health care. Both puts power in the hands of patients by providing information and opportunities previously unavailable to them.

Health care is the only industry where consumers have no idea how much they will pay for services until after they have received them. Powerful special interests, like insurance companies, hospitals and pharmaceutical companies, prefer to keep things as complicated as possible, shielding patients from the true price for medical services. At the executive order signing ceremony, a young woman shared the story about the stage 3 cancer that she successfully battled, but that caused her family tremendous financial hardship. Much of this problem was caused by the inability to shop for medical services. She had difficulty understanding why two bone scans done three weeks apart at two different facilities in the same city should differ in price by 30 percent.

Read the full article on Townhall.

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Refuting the Tortured Arguments Against Health Care Price Transparency

President Donald Trump signed a historic executive order on June 24 that will require hospitals and insurers to disclose medical care prices. Once enacted, patients will for the first time in decades have an unfettered view of the ugly underbelly of the health care beast.

Those who oppose health care price transparency rely on several arguments. One is that the process of revealing prices will prove very costly and that providers will pass this supposed expense on to patients.

This argument is ridiculous. The expense, if any, of posting health care prices will be infinitesimal to providers and vastly surpassed by the benefits to be created by empowering patients with additional pricing information. Prices are readily available on nearly everything sold throughout our economy. From a 25-cent gum ball to a $40,000 SUV, prices are almost always out front, posted, and prominent in U.S. markets. Only in medical care are prices obscured until long after the service is provided, leaving the patient with almost no negotiating power to get a fair price on these “gotcha” bills.

Read the full article at Townhall.com

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Physicians Applaud Executive Order Exposing True Health Care Costs & Opening Doors for Direct Primary Care Patients

FOR IMMEDIATE RELEASE
June 24, 2019

CONTACT
Dan Rene of LEVICK
202-973-1325 or drene@levick.com

PHYSICIANS APPLAUD EXECUTIVE ORDER EXPOSING TRUE HEALTH CARE COSTS & OPENING DOORS FOR DIRECT PRIMARY CARE PATIENTS

Transparency to Close Gap Between ‘Costs’ and ‘Price’ of Health Care and Allow for Patient Choice

[Washington, DC] [June 24, 2019] – At an event today at The White House, physicians from the Docs4PatientCare Foundation (D4PCF), the only health care organization composed of practicing physicians with hands-on, practical knowledge of the American health care system joined President Trump as he signed an Executive Order demanding transparency in what has become an opaque cost/pricing system.

At the event, physicians applauded the recognition of Direct Primary Care options allowing patients to use Health Savings Accounts for their care. These innovative relationships established between a physician and patient without the distraction of an insurance company or other third-party interference are increasing in the health care marketplace.

“In this age of information, we can compare prices on everything, except our health care, which places patients at a disadvantage,” stated Dr. Lee Gross, President of the Docs4PatientCare Foundation. “The prices patients pay for health care must be driven by the costs of that care, not a patient’s ability to pay nor a result of secret negotiations where the only motive is profit – at the expense of the patient.”

The Executive Order will compel disclosures of details on what it costs for insurers, doctors, hospitals etc., to provide health services. There is often a major delta between the costs of these services and the prices paid by patients, insurance companies, and the government.

“Until we know what the true costs are, having a fair pricing system is impossible,” Dr. Gross continued. “By developing rules that force everyone to show their cards simultaneously, we will finally achieve truth in the health care marketplace.”

The current system keeps patients and their doctors in the dark about pricing considerations – especially for the vast majority of predictive health care decisions.

The Docs4PatientCare Foundation team attended as guests of the White House and were recognized for their expertise and leadership in these transformational endeavors.

“While this Executive Order and subsequent rule changes may expose some warts in the previous contracting process, the patient will come out ahead. An informed consumer will be healthier and make better decisions. And doctors who pledge to first do no harm can take that a step farther and to do no financial harm to their patients too,” Dr. Gross continued.

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Please visit: http://d4pcfoundation.org/

For more information or to schedule an interview with the Docs4PatientCare Foundation leadership, please contact Dan Rene of LEVICK at 202-973-1325 or drene@levick.com

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Fixing High Healthcare Costs Should Help Patients And Not Insurance Companies

The latest attempt to tame the healthcare beast is a surprisingly bipartisan effort coming out of the Senate. The Lower Healthcare Costs Act of 2019, introduced by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) would attempt to solve a problem that has attracted considerable attention recently- surprise medical billing.

Surprise medical billing occurs when a patient who has insurance, receives a bill from a doctor after expecting the services they received to be covered and paid for by insurance. This troubling situation mostly occurs in an emergency situation and fortunately does not occur very often. However, when it does, it is aggravating to patients and costly.

The proposed Senate bill attempts to fix this problem by dictating that doctors not on insurance panels are paid a rate that is tied to the Medicare fee schedule in their community. This is a bad idea which will have far-reaching ramifications, ultimately harming patients in the long run.

Read the full op-ed on Townhall.com

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Major Health Care Innovation Still Stymied by IRS Roadblock

What is it that Americans really want from their health care system? Do they want high-deductible insurance plans, 80-20 insurance, PPOs, HMOs, or something else entirely?

Most consumers do not even bother to think of these things when envisioning their ideal medical system, as these are primarily insurance concepts—as opposed to health care concepts. Despite policymakers’ obsession with them, these insurance concepts do not reflect what most patients deal with daily.

Here’s what people really want: a well-trained, high-quality, caring doctor who will listen to them, accurately and compassionately address their concerns, and be available when needed. Direct primary care (DPC)—in contrast to third-party-payer models—achieves just that.

Read the full article on Townhall

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Direct primary care: The key to cost savings and improved health?

Decades ago, when a patient was too sick to go to the doctor’s office, the doctor made a house call. Though this practice seems old-fashioned now, most people would agree that the current system often leaves much to be desired. The exception could be the emerging concept of direct primary care and integrated health.

These days, when someone gets sick, they call their primary care doctor and, sometimes days later, they have a 15-minute appointment, which leaves little time to ask difficult questions or build a connection. The current system also does little to connect various different physicians, nurses, imaging centers, hospitals and beyond to each other, making the health care journey less efficient, less personal and more costly. A more personalized health care experience could improve the health and well-being of most people—and save employers money. Direct primary care could help us get there.

Read the full article on Benefits Pro

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Bills before Congress would allow use of Health Savings Accounts for Direct Primary Care Dues

HSAs are a type of savings account that allows people to set aside money before taxes to pay for qualified medical expenses such as deductibles, copayments, and coinsurance. Some in Congress want to extend those qualified medical expenses to include dues that members pay to direct primary care practices. Because DPCs don’t accept insurance or payment from third-party payers, they can offer unlimited primary care for typically less than $100 per month.

Bills Would Broaden HSAs

Sen. Marco Rubio (R-FL) introduced S. 12, the Health Savings Act of 2019. Cosponsored by Sen. Lisa Murkowski (R-AK), the legislation would expand what qualifies as a valid expense for the use of HSAs. Under current law, the Internal Revenue Service handles DPC fees differently from insurance premiums and copays, which are qualified expenses.

In the House, Rep. Mike Gallagher (R-WI) introduced H.R. 603, the Health Savings Account Expansion Act of 2019. The legislation would increase the maximum allowed contribution amount, repeal the restriction on using HSAs for over-the-counter medications, remove the requirement that a person with an HSA also be enrolled in a high-deductible health insurance plan, and allow the use of HSAs to pay for health insurance premiums and direct primary care service arrangements.

 

Read the full article at The Heartland Institute.

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Physician Heals Herself By Opening Direct Primary Care Clinic

Nicole Hemkes was growing tired of being another employee doctor. 

The Madison-area physician spent much of the past decade employed at hospital or group health care facilities, much like the vast majority of her peers in medicine. In fact, less than a third of physicians identified as private practice owners, according to a 2018 survey by the Physicians Foundation and Merritt Hawkins. 

Hemkes had had her share of insurance-based medicine, seeing her standard 30 patients a day, spending more time on paperwork than with the people she is supposed to serve. 

“A 10- or 15-minute appointment is just not enough,” she recently told MacIver News Service. “You’re kind of hooked to the computers because you have to have so much documentation done that you need to submit to a code that is going to bill for that visit, and that’s the way the health system gets paid.” 

“So much of what we do seems to be more focused on the billing and the payment rather than the patient,” the physician said. 

Read the full article at The MacIver Institute.

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