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The Advantage of Paying for Medical Care Directly

According to a PBS health report about a retiree on a Medicare Advantage plan, Z. Ming Ma was issued a prescription from her physician that cost $285 for a 90-day supply. “A month later,” the article says, “Ma and his wife were about to leave on another trip, and Ma needed to stock up on her medication.”

But her 90 days weren’t up, so Anthem wouldn’t cover it. “Ma asked the pharmacist how much it would cost if she got the prescription there and paid out of pocket,” the article says.

The total cash price was about $40.

This is not uncommon. In fact, a study from USC demonstrated that nearly 25 percent of all prescriptions filled at the pharmacy cost the insurer less than what the patient paid in a copay. Yes, that means paying cash is more affordable than using your insurance card.

 

Read the Full Article at The Hill

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More Patients Turning to ‘Direct Primary Care’

Having quick access to a primary care doctor 24/7 is very appealing to Mick Lowderman, 56, who is married with two children, ages 10 and 8. He pays a monthly membership fee to AtlasMD, a direct primary care practice in Wichita, KS.

“It’s awesome that I can call or text Dr. Josh Umbehr when my children are sick and that I have a solution before they leave for school,” he says.

For example, when one child woke up coughing recently, Mick and his wife, Jennifer, contacted ‘Dr. Josh,’ who asked them to put her on the phone to hear her cough and then take a picture of her throat and text it to him.

“He prescribed an antibiotic, which we picked up at his office the same day.”

 

Read the Full Article at WebMD

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Congress has a Prescription for Health Care’s Sickly Status Quo

Despite the problems that plague American health care, innovative ideas exist to cure what ails it. But many transformative approaches are languishing in obscurity compared to insurance-based, big-government alternatives. One idea, reforming Health Savings Accounts (HSAs), is a powerful antidote to the sickly status quo. And Senator Ted Cruz’s Personalized Care Act (S. 3112) would implement this much-needed solution. S. 3112 — which has a companion bill in the House, Congressman Chip Roy’s HR 5596 — would lift unnecessary HSA restrictions, let Americans spend HSA dollars how they see fit, liberate employers, and unleash Direct Primary Care.

Created in 2003, HSAs are already powerful tools that empower patients. Individually owned, these plans allow patients to place pre-tax dollars into an account and use the funds for certain medical expenses. Frequently confused with the much less advantageous Flexible Spending Accounts (FSAs), HSAs are the ultimate tax-advantaged savings modality. That’s because they are not taxed on contribution, growth or use for an “Eligible Medical Expense.”

Currently, however, needless restrictions prevent HSAs from achieving their potential — and widespread adoption. Insurance companies, fearful of losing any power, were able to include language that prohibits Americans from owning an HSA unless it is linked to an insurance company’s High Deductible Health Plan (HDHP). This unnecessary requirement forces patients who buy HSAs to also buy overpriced traditional insurance policies, limiting the appeal of HSAs.

Read the full article at RealClear Policy

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Commentary: Health care reform that’s superior to Medicare for All

Health care reform is shaping up as the defining issue of the 2020 election. According to Real Clear Politics polling, most voters say that health care is their most important issue.

For doctors, that’s no surprise. We hear complaints from our patients about the health care system every day. Chief among these is the exorbitant cost.

Average insurance premiums for employer-sponsored health insurance, which covers most Americans, have risen by more than 50 percent over the last decade. Deductibles have doubled.

How can families with median annual household incomes of around $60,000 pay $10,000 worth of combined premium and deductible costs per year?
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Direct Primary Care Could Bring Savings and Quality to Missouri Medicaid

Medicaid must be reformed to ensure its long-term survival. Over the past decade, Medicaid rolls have expanded faster than many states can afford. From 2013 to 2018, the number of Medicaid enrollees increased by nearly 28 percent, to more than 67 million. In 2017, the cost of Medicaid reached $581.9 billion, representing 17 percent of total healthcare spending nationwide.

In many states, the increased cost of health care can be traced to overregulation, rising drug and medical device costs, and increased use of long-term and behavioral health services. Even worse, bloated Medicaid programs, even in states that have not expanded, face viability problems. In Missouri, Medicaid costs have risen consistently over the past decade. According to the News Tribune, Medicaid costs have grown from 17 percent of Missouri’s general revenue in 2011 to 24 percent in 2018. In 2018, the Show Me State spent a whopping $10.3 billion on Medicaid.

Unfortunately, Medicaid cost overruns will continue to grow. According to a recent report from the Centers for Medicare and Medicaid Services, Medicaid expenditures are expected to rise at an average annual rate of 5.7 percent from 2017 to 2027, a rate that far exceeds annual U.S. gross domestic product growth. The Rapid Response Review, a study of Missouri’s Medicaid system that was completed in February predicts Medicaid spending could increase to as much as 30 percent of general revenue by 2023.

Read the full article at The Heartland Institute.

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Doctors picking direct care

Dr. Emilie Scott was only a few months into her first job when she started hearing the complaint: She was spending too much time with each patient.

Like many primary care doctors working in large medical systems, Scott was encouraged to see a new patient every 20 minutes. But that was barely enough time to talk and do a physical.

She eventually quit her job to try a new approach aimed at eliminating many of the headaches of traditional health care: tight schedules, short appointments and piles of insurance paperwork.

Instead of billing insurers, Scott now charges patients a $79 monthly fee that covers office visits, phone calls, emails, texts and certain medical tests and procedures. Scott typically sees six patients a day, down from around 30, and spends more time at each appointment. She hired two assistants to help handle paperwork compared with working with a department of billing specialists.

This approach — direct primary care — aims to leverage the extra time and money from avoiding insurance into improving care for patients.

“As far as our financial success, it does not depend upon having a team of people to figure out how to get money from the insurance company,” said Scott, who co-owns a private practice in Irvine, Calif., that serves about 900 patients. Scott said the practice has grown by word-of-mouth, without advertising.

In many ways, direct primary care is a return to a simpler time when doctors charged cash for their services. Patients say they appreciate the accessibility and simplicity of the system.

Read the full article at Times Union.

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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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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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