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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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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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States Move to Exempt Direct Primary Care from Insurance Regulations

Classifying DPC as not being insurance means these providers are not subject to insurance regulations that drive up the cost of health care. Direct primary care practices charge a flat fee for unlimited service. The providers can offer lower prices because bypassing the insurance system reduces administrative costs substantially. Members often supplement their care by buying insurance coverage through health-care sharing ministry programs which cover hospitalization and specialty care at a fraction of the price of traditional insurance plans.

According to DPC Frontier, an online resource for the DPC movement, 25 states have laws that define DPC as not insurance.  This year, insurance definition bills emerged in Arizona, Georgia, Hawaii, Maryland, Minnesota, New Hampshire, South Carolina, and Wisconsin.

The Arizona governor signed into law SB 1105 which addressed ambiguity in previous law by now specifically stating DPC plans are not insurance. Georgia became the 26thstate this year to not define DPC as insurance with the passage of SB18.

Read more at The Heartland Institute

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