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D4PC Foundation President Lee Gross, M.D Invited to the White House

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The impact of our years of teaching the benefits of protecting the doctor/patient relationship are fully bearing fruit.

Dr. Lee Gross as invited for a surprise visit to the White House to teach the staff and policy makers about the innovations reshaping the delivery of health care at the ground level all across the world.

This is another step in the fulfillment of President Trump’s executive order to HHS and various departments to do a full analysis of the U.S. Health Care System.  The goals include increasing access, lowering costs, and delivering better medical outcomes.

Direct Primary Care continues to come to the foreground as one of the best solutions for providing low cost and high quality care regardless of health insurance.  Dr. Lee Gross, President of Docs 4 Patient Care Foundation, has become the defacto expert in the practice model.

Watch Dr.Gross’s Field Update HERE

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Priced Out of Health Insurance, Americans Rig Their Own Safety Nets

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When their son Sky was born four years ago, Lindsie and Chris Bergevin were hit with a big surprise: $7,000 in bills for the birth that their health plan didn’t cover. Sky was two when the couple jettisoned their medical insurance, which helped them eventually pay off the debt.

Now that they’re ready to have a second child, they’re not going back to their old coverage, with its premiums of more than $350 a month. Instead, they’ve patched together an alternative through a religious group and a primary-care doctor whom they can visit anytime for a monthly fee.

“I was so jaded with the whole health-care insurance situation,” Lindsie, 35, says. “I just didn’t want to deal with it.”

The Bergevins, who rent a snug little house near downtown Boise, Idaho, are joining a small but growing number of Americans rigging their own medical safety nets. They’re frustrated by the high costs, opaque pricing, and maddening bureaucracy of health insurance.

In their quest for a different way, they’re meeting doctors like Julie Gunther who are also fed up. These physicians have opted to reject insurance, instead charging patients directly in return for more personalized care.

“I like to think we can protect people in vulnerable moments where they’re going to get lost like a widget,” Gunther said, “because they’re not a widget for us.”

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Epiphany is providing health care for patients who can’t afford Obamacare

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“Epiphany is a strange name for a medical company, but my partner, Dr. Bill Crouch, and I had an epiphany,” said Dr. Lee Gross, co-founder of Epiphany Health, 2975 Bobcat Village Center Road, North Port (EpiphanyHealth.org).

In 2010, they began riding the wave of a concept in health care that was just starting to swell. As a result, their small practice sees patients from all over the state — Lakeland, Orlando, Miami-Dade, Coco Beach. They drive across the state, Dr. Gross said, because they can afford what we’re doing here.

So what is it that makes Epiphany so different?

The two physicians had been in practice since 2002.

“We were in the rat race of independent practice primary care, where you’re trying to funnel the patients through as fast as possible, keeping office visits to seven minutes, fighting with insurance companies to get procedures and medications approved. It ended up feeling like we were treating the chart and the computer and the insurance company but not providing good medical care. We decided there had to be a better way to do this.”

Read the full article at the Charlotte Florida Weekly.

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The doctor is out? Why physicians are leaving their practices to pursue other careers

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This “bottleneck effect” doesn’t usually sour grads on staying the course, Fowler finds, but he does see plenty of doctors in the later stages of their careers hang up their stethoscopes earlier than expected. Some cite electronic health records (EHRs) as part of the reason — especially old school doctors who don’t pride themselves on their computer skills. New research by Stanford Medicine, conducted by The Harris Poll, found that 59 percent think EHRs “need a complete overhaul;” while 40 percent see “more challenges with EHRs than benefits.”

And then there are those doctors who left medicine because the cons of the job started to far outweigh the pros.

“I began to feel like an easily replaceable cog in the health care machine. With the [enforcement] of EHRs, I had to spend more time as a scribe. One night a child I was treating had a seizure and I couldn’t get the medicine to enable them to breathe because their chart wasn’t in the system yet. This kid was fixing to die and I, the doctor, couldn’t get the medicine. It was demoralizing.”

Baxter left pediatric emergency medicine to head a company that develops physiological products for personal pain management.

Read the full article at NBC.

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My wife’s story: Anatomy of an insane health care billing system

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By Carl C. Schuessler

Recently, my wife went to the doctor with stomach issues.  The doctor recommended a simple diagnostic test called a HIDA scan.  We have an HSA high-deductible health insurance plan with a $6,450 deductible, meaning we would be paying for the procedure out-of-pocket until our deductible was met.

Before my wife left the doctor’s office, she asked the receptionist what she thought was a simple question: “How much is this going to cost?”

The receptionist had no idea — and she had no way to check.  She looked at my wife like it was an unreasonable question.  A manager contacted a third-party billing agency to get her a quote, which ended up being nothing close to what we actually paid in the end.

Economic models assume participants have perfect information.  In reality, they often have no information whatsoever.

Read the full article at Benefits Pro.

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This surgeon wants to offer cheap MRIs. A state law is getting in his way.

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Dr. Gajendra Singh walked out of his local hospital’s outpatient department last year, having been told an ultrasound for some vague abdominal pain he was feeling would cost $1,200 or so, and decided enough was enough. If he was balking at the price of a routine medical scan, what must people who weren’t well-paid medical professionals be thinking?

The India-born surgeon decided he would open his own imaging center in Winston-Salem, North Carolina, and charge a lot less. Singh launched his business in August and decided to post his prices, as low as $500 for an MRI, on a banner outside the office building and on his website.

There was just one barrier to fully realizing his vision: a North Carolina law that he and his lawyers argue essentially gives hospitals a monopoly over MRI scans and other services.

Singh ran into the state’s “certificate of need” law, which prohibited him from buying a permanent MRI machine, which meant his office couldn’t always offer patients one of the most important imaging services in medicine. He has resorted to renting a mobile MRI machine a couple of days a week. But it will cost him a lot more over time than a permanent machine would, and five days a week, his office can’t perform MRIs.

Now Singh has had enough. He filed a lawsuit Monday in North Carolina Superior Court to overturn the state law, news that he and his attorneys from the Institute for Justice shared exclusively with Vox.

Singh specializes in complex liver transplants and surgeries to treat gastrointestinal cancers. He appreciates the importance of a good MRI. “Those patients need imaging. As a surgeon, we need to see what we’re going to do. We often need a lot of imaging,” he told me in a phone interview.

As Vox’s Sarah Kliff reported as part of her project to collect emergency room bills, Americans can sometimes be charged as much as $24,000 if they get an MRI at a hospital’s ER. Singh is offering a substantial discount on a medical service plagued by high costs.

But because his office can only offer MRIs twice a week, they must regularly turn away patients who need them — some of whom shouldn’t wait to get important medical scans.

“We lose all those patients,” said Singh, who also owns his own surgery practice.

Certificate-of-need laws were in vogue 40 years ago. But lawmakers quickly discovered that, in practice, they often served to protect hospitals from the competition. Forty-nine states had such a statute at one time, but in the decades since, 14 states have repealed theirs.

Read the full article at Vox.

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Democrat Socialists and Their Single-Payer Healthcare Agenda

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There are several irrefutable facts that must be stated together to understand what is happening with healthcare in the US. The first is that the Democratic Party has been split because of the ascension of the Democratic Socialists. Their ideation has significantly influenced the direction of the party as a whole, moving it further left than ever before. The second is that the Democratic Socialists do not like Obamacare any more than those on the right because it is standing in the way of one of their central issues- the creation of a single payer system. The third is that this radical idea is taking hold as part of the Democratic platform and is generating popular support as Obamacare fails and the GOP does nothing to solve this mess.

What was once considered a radical idea and impossible to imagine in any serious discussion about American healthcare, single payer has become very mainstream as a Democrat talking point regarding healthcare. If one doubts this, consider the fact that the Bernie Sanders bill- Medicare for All Act- S1804, has 16 current sponsors, including highly visible names like Cory Booker, Kirsten Gillibrand, Kamala Harris and Elizabeth Warren. Many of these individuals have been mentioned as presidential candidates for 2020.

Read the full article at Townhall.com. 

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D4PC Foundation Applauds the Expansion of the STLDI

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“Docs 4 Patient Care Foundation applauds the release of the HHS rule for expansion of Short-Term Limited Duration Insurance plans (STLDI).  As one of the nation’s leaders in educating Direct Primary Care (DPC) physicians, we are frequently confronted with the challenge of finding affordable coverage to wrap-around DPC.  When paired with a Direct Primary Care membership, STLDI will help provide affordable access to routine care along with affordable major medical coverage.  This is precisely the regulatory relief that we have been seeking from the Trump Administration.”

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Dr. Umbehr appears on the Hannity Show to Oppose HR 6317

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One of the nation’s biggest proponents of the “direct care movement” in the United States stopped by ‘The Sean Hannity Show’ this week, warning those who support co-operative healthcare that a new Senate bill poses a major risk to the low-cost plans.

Dr. Josh Umbehr has spent over a decade launching hundreds of “concierge service” healthcare programs across the country, but new legislation passed days ago creates a threat towards the alternative options.

“There’re now hundreds of these co-ops that he’s developed around the country. Now they’re at risk because of a bill that passed in the Senate,” said Hannity.

“There was a bill that came out of the Ways and Means committee that isn’t great for supporting the direct care movement and patients overall […] We’re hoping to fix it in the Senate, and I think there was a bit of lobbying in the background by more corporate groups,” said Dr. Umbehr

Listen to the Interview and Read Action Points HERE


Background:  Direct Primary Care is the only major medical service offered by doctors you are forbidden to pay for with YOUR Health Savings Account (HSA) dollars.

The IRS in 2014 issued a letter defining DPC as a health plan and disqualified from HSA dollars (like health insurance). HR 365 was a simple piece of legislation designed to fix the problem.

Without debate, the legislation was replaced with HR 6317 in the House Ways and Means Committee and passed out of committee.

OUR original analysis finds the bill creates a regulatory control that is precisely what DPC doctors seek to avoid, undermining the very freedoms that have made the practice model succeed.

Although improved since last reported, this bill creates the regulatory foundation, price fixing, and centralized control that is at the heart of the problems in American health care.

Stay tuned to see how things change in the Senate version.

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Proposed HR 6317 Would Expand Government Regulatory Control of DPC through HSAs

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HR 365 Replaced by HR 6317 Expanded Government Regulatory Control of DPC through YOUR HSAs

Official Statement from Docs 4 Patient Care Foundation:
We are pleased to report that we were successful in removing the critically flawed language that would have dramatically restricted and regulated independent DPC practice.

The issue of CPT coding has been eliminated.

This is still generally not a great bill, but it is no longer critically flawed. We are now in a better position and feel comfortable supporting it with the understanding that other important issues will be able to be addressed in the Senate.

Thanks to an incredible team of dedicated physicians and staff that were able to pull off this big accomplishment in such a short period of time!

– Lee Gross, M.D.
President, Docs 4 Patient Care Foundation

Read the Amended Legislation HERE.

Background:  Direct Primary Care is the only major medical service offered by doctors you are forbidden to pay for with YOUR Health Savings Account (HSA) dollars.

The IRS in 2014 issued a letter defining DPC as a health plan and disqualified from HSA dollars (like health insurance). HR 365 was a simple piece of legislation designed to fix the problem.

Without debate, the legislation was replaced with HR 6317 in the House Ways and Means Committee and passed out of committee.

Our analysis finds the bill creates regulatory control that is precisely what DPC doctors seek to avoid, undermining the very freedoms that have made the practice model succeed.

This Bill will be hailed for finally allowing HSA dollars to be used for DPC.  It is a Trojan horse bringing the worst of Obamacare to DPC.

This bill creates the regulatory foundation, price fixing, and centralized control that is at the heart of the problems in American health care.

Dr. Lee Gross filmed a video analysis in his weekly update from Epiphany Health well worth the time.
Watch HERE.
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