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Do Certificate-of-Need Laws Still Make Sense in 2019?

It’s a usual regulation in a healthcare industry known for plenty of unusual rules: In 36 states and the District of Columbia, a healthcare provider hoping to open or expand her patient offerings must first prove to regulators that her community needs the service.

Providers can spend years and burn through tens or even hundreds of thousands of dollars to prove this need and thus obtain what is called a “certificate of need” (or CON). The CON process can be required for both small and large investments: from hospital beds and gamma knives to new hospitals and neo-natal intensive care units.

Originally intended to discourage the use of expensive technologies and procedures, in many states a CON is now required for relatively lower-cost modes of care such as ambulatory surgery centers and for services unlikely to be over-prescribed such as drug-rehabilitation services and hospice care.

The federal government once required states to have CON rules in order to obtain certain federal funds. But since the repeal of that mandate in the late 1980s, a substantial minority have done away with their CON programs. Of those that have retained the regulation, many have scaled it back. In June, Florida moved to eliminate its CON requirements for new hospitals, specialty hospitals converting to general hospitals, and for a raft of other service providers such as children’s care and substance abuse hospitals.

Read the full article at Modern Medicine Network.

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What Republicans and Democrats can do to fix our health care

Anyone watching the most recent round of Democratic presidential primary debates should recognize that in both the first and second sets of debates, all the candidates worked from the assumption that Americans face a binary choice: government-run health care or private health insurance.  Republican responses to the debates made the same assumption.

Big Brother or Big Insurance — love one, hate the other.  That’s the anemic range of health care messaging to expect from Democrats and establishment Republicans alike.  The problem?  Both sides are wrong — myopically, expensively wrong.

Democrats insist that you must love government-run health care and hate private insurance companies.  Republicans insist that you must love health care from insurance companies and hate government-run options.

But government-run and private insurer–run health care are both bad options, especially when Democrats and establishment Republicans present them as the only ones.  That’s why I choose option three: patient-run health care.  So do my patients, and so do countless other patients across the country — not that you’ll hear about them in the debates.  Such patients — many of them low-income — buy health care directly from their doctors for pennies on the dollar compared to what Democrats and establishment Republicans would have patients (or taxpayers) pay for insurance.

Instead of patient-run health care, expect to hear more about its opposite: government (single-payer) health insurance.  On its face, it sure sounds good: free health care!  Who wouldn’t like that?

Read the full article by Chad Savage, M.D. at American Thinker.

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Trump’s New Executive Order: Unleashing HSAs For Direct Primary Care

This incredibly important point about HSAs is buried deep in the EO: “Within 180 days of the date of this order, the Secretary of the Treasury, to the extent consistent with law, shall propose regulations to treat expenses related to certain types of arrangements, potentially including direct primary care arrangements and healthcare sharing ministries, as eligible medical expenses under section 213(d) of title 26, United States Code.”

This passage made direct primary care doctors literally jump with excitement. So, what does it mean?

DPC doctors are a little-known category of physicians who have risked their professional careers on a novel, cost-effective, and patient-centered approach to medical care. They’ve cut out the insurance middlemen and put patients back in charge of their care. For a low monthly rate, usually between $39 and $99, patients get all their primary care visits with no copayment or additional charges. DPC physicians usually schedule in 30-minute to one-hour blocks, in contrast to the rushed visits of insurance-based practices. More than half of all medical care occurs within primary care offices, and with the extended time DPC doctors give patients, they can likely treat an even broader array of medical conditions. They even help patients find cheaper prices on medications, labs, and imaging, such as MRIs. Pairing a DPC subscription with catastrophic health insurance provides a much cheaper, and much better, alternative to the bureaucracy of traditional insurance plans.

Read the rest of Chad Savage’s Op-ed at Townhall.com

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Dr. Josh Umbehr on the Rapid Growth of Direct Primary Care

From calamity springs opportunity—opportunity for rational, productive individuals willing to get creative and work hard to uncover it. Millions of Americans are stuck holding insurance policies that do little for them other than drain their bank accounts, under threat of hefty government fines if they drop their policies altogether. Innovative family practice physicians such as Dr. Josh Umbehr of Atlas M.D. may not be able to dismantle intrusive health-care regulations, but they are finding ways to sidestep them and provide excellent care to their patients at surprisingly affordable prices. I spoke with Dr. Umbehr about how direct primary care has grown in recent years and how it’s shaping the future of medicine in America.

Read the full interview at The Objective Standard.

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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.

Listen to The Accad & Koka podcast.

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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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