“The FMA had a national expert on call during a multi-year campaign to eliminate roadblocks for Florida’s Direct Primary Care doctors. Pioneering DPC physician Dr. Lee Gross was a key advisor to the FMA in drafting legislation.” – Florida Medical Association
The National Briefing on Health Care Policy Begins
The frustration over health care policy at the Federal level has moved national radio host Sean Hannity to launch the national discussion with the doctor innovators on the front lines of health care.
Dr. Josh Umbehr and our own Dr. Lee Gross joined Hannity on his national radio show to kick off a regular Tuesday afternoon national briefing on the impact of free market medicine.
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.”
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.
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!
President, Docs 4 Patient Care Foundation
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 lettter 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.
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.
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.
This Handbook on Healthcare Reform is an effort by the Thomas Jefferson Institute for Public Policy to bring ideas to the table for discussion and legislative debate in order to highlight areas where Virginia and other states can take action to reduce costs, increase availability and thus broaden the number of people who can better afford, thanks to the reforms outlined in this Handbook, to see a doctor.
The Thomas Jefferson Institute worked closely with Dr. Hal Scherz of Atlanta to create this special Handbook on Healthcare Reform. We wanted to bring together the ideas of doctors and other experts in the field of Healthcare on how healthcare can be reasonably reformed so that a better system is the result.
Dr. Scherz reached out to colleagues around the country to write essays on specific areas of healthcare that they felt should be reformed in order to better serve their patients. These doctors work within the current web of regulations and they provide innovative ideas on creating a less bureaucratic system that can improve the overall healthcare delivery system. And we found a few essays from academic healthcare experts to add ideas to this Handbook.
As the founder of “Docs 4 Patient Care,” Dr. Hal Scherz has a deep interest in how healthcare can be improved for all of us and he spent a good deal of time in helping us put this Handbook together. He is well-respected urologist and is deeply interested in improving the healthcare system in this country. We deeply appreciate his time and effort in this project. 5
This Handbook on Healthcare Reform brings ideas to the table for public debate and discussion. It is not an effort to support specific legislation, although it is hoped that the ideas presented herein will become public policy as is the case with Direct Primary Care (DPC) that became state policy earlier this year when Governor Terry McAuliffe signed the legislation into law. This DPC law will allow those in underserved areas to gain better healthcare access if it works as it has in other states. We are proud to have had a small role in putting some of the early pieces together which ultimately resulted in this new law here in Virginia.
The Minnesota Senate is considering making it easier for health care providers and patients to enter into direct primary care (DPC) agreements.
Senate File 2723 (S.F. 2723) would define direct primary care agreements as a form of health care instead of as health insurance, freeing primary-care providers from the state’s insurance regulations.
Instead of billing insurance companies or the government for patient care, doctors providing DPC charge patients a regularly scheduled fee and list procedure prices up front.
State Sens. Scott Jensen (R-Chaska), Jim Abeler (R-Anoka), Mary Kiffmeyer (R-Big Lake), and Michelle R. Benson (R-Ham Lake) introduced the bill on February 26.
The state Senate’s Commerce and Consumer Protection Finance and Policy Committee met on March 28 to debate S.F. 2723 but did not vote on the bill.
Dr. Lee Gross, president of Docs 4 Patient Care Foundation, a nonprofit organization committed to promoting the sanctity of the physician-patient relationship, says DPC can improve the quality of care.
“The DPC practice is very nimble,” said Dr. Gross. “It can respond to the patient’s immediate needs. You don’t need to bring them in the office to get paid like you do in the insurance system, and you’re not going to upcharge the patient just because they have more complicated problems that need more attention.”
Read the full article at Heartland.