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Direct Primary Care Funding Trends Upward

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Private-sector funding for primary care clinics is increasing, as companies seek new opportunities for investment in the $3.5 trillion U.S. health care market.

One Medical, a primary care provider that offers concierge-style health care services giving patients off-insurance treatment for a flat membership fee, announced a $350 million investment from private equity firm the CarlyleGroup in August. Having previously garnered funding from firms such asBenchmark Capital, Google Ventures, Maverick, and JP Morgan, One Medical says it plans to double the numbers of clinics and members under its umbrella.

Concierge medicine offers health care to insured individuals who wish to have a better relationship with their primary care provider and are willing to pay a monthly fee. The monthly cost of concierge medicine is usually around $200 per month, on top of insurance payments, but some doctors charge tens of thousands of dollars per year. Concierge services provide medical care to patients 24 hours per day, seven days a week; provide contact information for easier access; make same-day appointments, and stay with a patient as long as it takes to meet his or her medical needs.

Read the full article at the Heartland Institute.

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The healthcare system is a racket — direct primary care could fix it

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Everyone has a healthcare horror story.

A hidden charge on the hospital bill. A last minute test or scan that ends up costing four figures. Hours spent on the phone with insurance companies to follow up on a claim and get a reimbursement. Prescriptions costing hundreds of dollars.

And it’s getting more expensive.

Since 2007, the cost of healthcare has risen 21.6 percent, while all other prices in the economy have risen by just 17.3 percent, according to the Kaiser Family Foundation.

It’s become an unfortunate reality for many, and it’s been rightly pushed into the arena of politics.

But despite the well-intended reforms of the past two decades, including the Affordable Care Act, millions are still feeling the pinch. Why?

Too often, talk of healthcare reform is focused on insurance rather than care. It’s less about how the doctor treats your family and more about who foots the bill. Almost no one can get a straight answer about the price of procedures or medicines.

Medical insurance, once a simple way to cover higher-than-normal expenses, has become a catch-all for almost all health spending. It’s no longer about surprise injuries and illnesses. Insurance is now used to cover every ache, pain, anxiety, pill, and more. It’s like using car insurance to cover every oil change, new windshield wiper, or tire.

And in order to recoup the amount they give out, insurance companies must price their options accordingly, which leads to higher prices for consumers. That’s why healthcare expenses in 2016 amounted to 17.8 percent of GDP, higher than any other industrialized country.

At least one new doctor-patient arrangement is promising a revolution in consumer choice by bypassing insurance altogether. It’s called direct primary care, and it’s catching on across the country.

Rather than relying on insurance for ordinary health expenses, these new doctor clinics rely on monthly fees from patients, usually less than $100.

If anything more is required during doctor visits, the prices for every service and test are transparent and don’t vary depending on your plan. By not accepting insurance of any type, each clinic saves on administrative costs and overhead, prioritizing patients over costly insurers.

The results are just as intended: lower costs, more preventive care, and more face time with medical professionals.
Read the full article at the Washington Examiner.

 

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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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Is This What All Hospitals Think of Primary Care Docs?

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Becker’s Healthcare spoke with Cathy Jacobson, president and CEO of Milwaukee-based Froedtert Health, prior to speaking on a panel at Becker’s Hospital Review 7th Annual CEO + CFO Roundtable titled, “The Digital Imperative: The Open & Shut Case for Innovation”.  All this gobbledygook means she is a pretty big deal to other administrators.  I was tipped off by Shane Purcell MD about her thoughts on primary care physicians highlighted in the piece:

Q: What’s one conviction in healthcare that needs to be challenged?

CJ: That every patient needs a primary care physician.  As we start stratifying our patients into distinct populations based on their health needs and develop that insight further into consumer driven wants, we are finding that a substantial sector of the population does not want or need a primary care physician relationship.  People need primary care but not necessarily a physician relationship. We need to stop trying to fit patients into our health system-driven model and develop the means to serve their health needs on their terms.  If we don’t, someone else will.

How does that make you feel?  Pretty crappy, right?  I have known this for a long time.  Hospitals want patients to be linked to THEM and not you as a doctor.  You should have noticed their commercials over the years with hospitals saying “as your healthcare provider”, etc.  It is about wordplay and confusion to make patients feel that the hospital is the doctor and the doctor is the hospital.   We know that this isn’t true. If doctors and nurses left the system then they pretty much just have an empty building.

Read the full article at Authentic Medicine.

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Legislation Allowing Patients to Use HSAs for DPC at Risk

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From AAPS:

Earlier this week we heard the good news that H.R. 365 was finally going to be considered by the House Committee on Ways and Means, bringing the use of Health Savings Accounts (HSAs) for Direct Patient Care (DPC) one step closer to reality.

Then we learned “a few small changes” had been made to the bill. Unfortunately the “few small changes” have greatly damaged the legislation.

You can read a copy of the latest bill here: https://goo.gl/B6imgQ.

Under the new language, DPC practices would have to comply with several federal requirements in order to become HSA-eligible. One provision limits the care provided under the agreement to specific CPT codes.  Another would prohibit DPC arrangements priced over a certain threshold from being HSA-eligible. Others further limit how the pricing can be structured and what care can and cannot be included. Specialists would be blocked from offering innovative HSA-eligible monthly membership payment arrangements.

You can read a full summary of the legislations status at AAPS.

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A different type of family medicine

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A growing number of doctors across the country fed up with the costs of medical care are switching to a model that cuts health insurance out of the equation, and two of those doctors are located in Moscow.

The direct primary care model means the doctor does not participate in insurance plans, and the enrolled patient pays a periodic membership fee rather than paying for every visit. The patient does not have a co-pay, and the membership fee goes directly to the practice instead of a third party.

According to dpcfrontier.com, there are nearly 850 DPC practices in the U.S.

Dr. Emily Todd will open her direct primary care family medicine practice July 23 on 904 S. Jefferson St., with a grand opening on July 25.

Todd said she was inspired to start her own DPC clinic after attending a conference where many doctors discouraged by the standard insurance model spoke of the benefits of direct primary care. Todd said she shared their frustration.

She said the increased overhead costs associated with insurance forces doctors into seeing more patients in a shorter period of time. She anticipates the direct primary care model will change that.

“It lets us focus on more personalized care and longer visits,” she said.

Read the full article at the Daily News.

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