CON laws help hospitals, but they hurt patients

In his recent State of the Union address, President Trump pointed out that although progress is being made on a variety of health care issues, health care costs are just too expensive for the average American.

One reason is this: Hospitals are the most expensive delivery point in the health care system, and ironically, an increasing amount of medical care is being directed there. Complicating this issue is that no one can be sure how much a hospital will charge.

Two patients can receive identical services and leave the hospital with vastly different bills. Furthermore, because of bizarre payments by insurance companies, care in the hospital can cost five to 10 times more than care by the same doctor in an outpatient setting not owned by the hospital.

Read the full article at Georgia Health News.


Physician-dispensed generics proposal pitched to Senate panel

What if doctors could not only prescribe drugs to their patients but also dispense them–no writing a prescription and sending it off the pharmacy? Not only would it be more convenient, it could be cheaper—a lot cheaper.

That’s the premise of a proposal put before the Senate health committee this week. Dr. Josh Umbehr, cofounder of Kansas-based Atlas MD, one such company providing generics directly to patients says it’s much cheaper than alternatives. In fact, Umbehr tells Modern Healthcare, “I’m cheaper than 340B.”

Umbehr related to the committee and chair Lamar Alexander, R-TN, that his practice, which he terms a “blue-collar concierge” direct primary care model that takes monthly membership fees from patients instead of accepting Medicare, Medicaid and private insurance, has a cabinet stocking about $50,000 in medications. The markup on those 200 different medications? About 10 percent. And since he gets extremely low prices on generics, his patients save money.


Read the full article at BenefitsPro.


Direct primary care physicians are not concierge doctors

Across this country, DPC practices are filling an important niche by providing care for underserved patients. But rather than indenturing themselves to a government or corporate entity, physician-owners of DPC practices are providing care on their own terms, without bureaucratic headaches and red-tape frustrations.

Direct care cuts out third-party payers like Medicare, Medicaid, and insurance companies. Instead, patients pay the doctor directly, usually through a monthly fee, which averages $77 for DPC practices.

Because direct care doctors are not beholden to the insurance company, they spend less time on unnecessary documentation and more time on patients. And because doctors don’t have to spend a fortune trying to get paid by an insurer, they can often keep their overhead remarkably low, passing savings along to patients.

Affordable health care is critical — especially to those paying for medical care out-of-pocket – like the 28.5 million without insurance, and the increasing number of Americans with high-deductible plans.


Read the full article at


Direct Primary Care: Dr. Lee Gross on The Paradocs Podcast

This week, Dr. Lee Gross went on The Paradocs Podcast to discuss why Direct Primary Care is the future of medicine.

“If there is one thing patients and doctors agree about when it comes to primary care it’s that it isn’t properly working for either one. Doctors have too little time to spend with patients, can only address one or two problems at a time, and spend most of the little face time they get staring at a computer screen than at their patient. Patients end up spending a lot of money on copays, laboratory studies, and visiting specialists because the doctor is unable to use his or her 22,000 hours of training on treating minor ailments.”

Listen to the full podcast below.



Why Do Americans Settle for Our Broken Health Care System?

It is no secret the U.S. health care system is badly broken. From the lack of transparency and inflated billing to a looming physician shortage, everyone suffers.

In recent years, significant resources and attention have been dedicated to researching and discussing various perceived problems in the current system, and the list of flaws is seemingly endless. For starters, it is next to impossible for many sick patients to set an appointment with a primary care provider within 24­–48 hours. (That’s why there’s now a whole industry of walk-in clinics that has emerged in recent years.) And when primary care office visits finally do occur, often after a few weeks of waiting, they usually last under 10 minutes. The hurried physicians hosting such visits are typically so busy that they don’t even have time to maintain eye contact, because they have to enter mountains of data into their electronic heath records database.

Many patients are allowed only one complaint per visit, and having no time, primary care physicians often can do little more than generate a referral to some other highly-paid medical specialist, which forces patients to spend yet another day waiting around a doctor’s office—after weeks or months of waiting for another appointment.

And let’s not forget about insurance. Despite billions of dollars spent by governments, it remains terribly expensive. Deductibles and premiums combined cost millions of families at least as much as a second mortgage or rent payment would.


Read the full article at RealClear Health


Beat the Clock: Why I Chose Direct Primary Care

For whatever reason, being 35,000 feet in the air makes me reflective. During one flight, I had a flurry of thoughts, and the reason I decided to get into this whole mess of direct primary care spilled out of me. I want to share it here because if you don’t know why — or you can’t convey why — you’re doing something, what’s the point in doing it?

In line with my desire to have a career that served others, I had the opportunity to do my residency in family medicine at a federally qualified health center in Denver that also served as that metro area’s international refugee intake clinic. We saw people from all walks of life and tended to each and every person in the same way, under the same constraints and system that dominates health care.

As I advanced in my training, more and more patients were added to my schedule. At first, I was expected to see 12 patients in a day. Then it crept to 16, 18, 20 and peaked at 22 at the end of my training. A schedule like that meant I was starting a new patient visit every 20 minutes. If I wanted to place any orders, coordinate care, look up the best medical evidence, seek advice (I was, after all, in training), or simply document the visit, that face-to-face time with the patient was squeezed to 12 minutes or less. This time crunch was further complicated by the fact that more than half of our visits were translated — leaving half the amount of time to realistically care for and communicate with someone.

Read the full article at AAFP.


Burnout Among Doctors Is A Public Health Crisis, Report Says

Increasing burnout among physicians is a dire public health crisis, new research out of Harvard says.

The paper cites research that nearly half of American doctors experience symptoms of professional burnout. And a 2018 survey found that 78 percent of over 8,000 physicians polled reported feeling burned out at least sometimes.

“At some point, you can’t go much higher, or you’re going to hit 100,” said Dr. Ashish Jha, dean of global strategy at Harvard T.H. Chan School of Public Health and an author on the new study. “We’ve got to start addressing this.”

Read the full article at WBUR.


Small fix, huge potential results

Dr. Lee Gross, President of the Docs 4 Patient Care Foundation and the founder of Epiphany Health Direct Primary Care used an op-ed to describe an easy change in the law the Trump Administration could make that would open up enormous amounts of access to low cost, quality healthcare. The change would expand the use of health reimbursement account (HRA) funds to allow for expenditures on direct primary care (DPC):

HRAs are employer-funded accounts used to augment group health plans. Contributions made to HRA accounts are not taxed. Under Obama-era rules, HRAs can be used by employees to pay for qualifying health expenses, as determined by federal regulations and employers, in conjunction with a group health insurance plan.

HRAs can, for example, be used by people to cover out-of-pocket costs for a medical procedure. Funds that remain in an HRA account at the end of each year can be rolled over to the following year, encouraging health care savings. Although HRAs currently offer some employees and their family members important benefits, they have been limited dramatically by federal agencies — a problem the Trump administration is now working to solve.

The administration could improve its proposed rule by clarifying that patients who pay for direct primary care (DPC) agreements would be eligible for reimbursement through their employer’s HRA. By classifying DPCs as a qualifying health-care expense, employees could use their HRAs to pay DPC costs, making it easier than ever for them to have access to more affordable primary care services.

Read the full article at John Locke


U.S. Health Care Spending Highest Among Developed Countries


The United States, on a per capita basis, spends much more on health care than other developed countries; the chief reason is not greater health care utilization, but higher prices, according to a study from a team led by a Johns Hopkins Bloomberg School of Public Health researcher.

The paper appears in the January issue of Health Affairs.

The researchers determined that the higher overall health care spending in the U.S. was due mainly to higher prices—including higher drug prices, higher salaries for doctors and nurses, higher hospital administration costs and higher prices for many medical services.

The paper finds that the U.S. remains an outlier in terms of per capita health care spending, which was $9,892 in 2016. That amount was about 25 percent higher than second-place Switzerland’s $7,919. It was also 108 percent higher than Canada’s $4,753, and 145 percent higher than the Organization for Economic Cooperation and Development (OECD) median of $4,033. And it was more than double the $4,559 the U.S. spent per capita on health care in 2000—the year whose data the researchers analyzed for a 2003 study.

The researchers, along with the late Princeton health care economist Uwe Reinhardt, who died in 2017, came to the same conclusion in their well-known 2003 study, “It’s the prices, stupid: why the United States is so different from other countries.” The new analysis is in part a tribute to the late Reinhardt.

“In spite of all the efforts in the U.S. to control health spending over the past 25 years, the story remains the same—the U.S. remains the most expensive because of the prices the U.S pays for health services,” says lead author Gerard F. Anderson, PhD, a professor in the Bloomberg School’s Department of Health Policy and Management.

Read the full study at John Hopkins.


Do Health Care Consumers Suffer from Health Insurance Stockholm Syndrome?

During a Swedish bank robbery in 1973, police were baffled when the hostages became so irrationally attached to their captors that one of the hostages recounted to a reporter for The New Yorker“How kind I thought he was for saying it was just my leg he would shoot.” This condition of inappropriate attachment to one’s captor subsequently became known as “Stockholm syndrome.”

With all the abuse heaped onto U.S. consumers in the current health care system, reasonable people might wonder: Are American health care consumers also suffering from this bizarre condition?

Most people recognize much of the current health care system is broken, unnecessarily complex, and wildly inefficient. There are long waits to see a doctor, followed by short office visits, and conflicts of interest permeate the market. All these issues take a toll on tens of millions of people every year, both physically and financially. At an average cost of $10,739 per person, the U.S. health care system costs more than twice the average spent by other comparable countries.

With a system this dysfunctional, it’s strange more people aren’t clamoring for an entirely new, better model. Instead, similar to the hostility the Swedish hostages expressed toward the police who were trying to rescue them 45 years ago, many American health care consumers are extremely skeptical of any market-based changes to the current system—even ones that have repeatedly been proven to yield impressive results.

“What kind of scam are you pulling?” is a common refrain espoused by many disbelieving people when first they learn of much more cost-effective and patient-friendly options such as direct primary care (DPC) and health sharing organizations. DPC offers dramatically improved access to care, same-day accessibility, and telemedicine at incredibly affordable rates. How? By allowing doctors to contract directly with patients, thereby avoiding costly and intrusive health insurance middlemen. Think about it: You wouldn’t use your car insurance to pay for a new tire or oil change. Why? Because it’s much cheaper to pay for these services out of pocket than it would be to have large insurers work with your local mechanic. The same logic applies with primary care doctors.

Read the full Op-Ed at