Direct primary care can rein in America’s out-of-control healthcare costs

By: Dr. Lee Gross

While Democrats and Republicans debate the merits and drawbacks of reforming America’s broken health insurance system, few policymakers are paying attention to perhaps the biggest reason health insurance is so expensive: The actual cost of healthcare, which insurers have to pay, is out of control.

There are many reasons the cost of providing healthcare has been steadily rising in most sectors of the healthcare industry. One of the most important is that the traditional health insurance model wastes piles of cash. It pays health insurers to act as middlemen between patients and their doctors. Patients continue to use their health insurance to pay for virtually every healthcare service, including those that they could easily pay for on their own, like primary care visits, flu shots, and routine exams.

Insurers’ involvement in nearly every primary care visit is causing healthcare expenses to skyrocket. Patients are being forced to pay extra so insurance companies can facilitate transactions they really don’t need to be involved in. Not only does this cause the cost of primary care services to rise, it also forces doctors to squander time filling out paperwork instead of treating patients. Some doctors choose to hire more staff to handle much of the administrative work, also contributing to the rising cost of providing primary care.

As I recently noted in testimony before the U.S. Senate Committee on Health, Education, Labor, and Pensions, “We don’t expect our homeowner’s insurance to pay for blown light bulbs or routine maintenance. Imagine how complex and expensive it would be to purchase gasoline if we used our auto insurance to pay for fuel. This is what we expect from our health insurance, yet we are surprised that it is expensive, inefficient, and impersonal.”

Fortunately, there is a better way to provide primary care, one that offers high-quality healthcare services for much less money and without inflicting mountains of complicated insurance paperwork and government regulations on doctors.

Direct primary care is a membership-based primary care model that provides patients with a set number of healthcare services in exchange for a flat monthly fee. At Epiphany Health, the direct primary care practice I founded in North Port, Fla., we charge just $65 per month for an adult membership and $25 for one child. (A membership for each additional child is just $10.) A family of four pays only $155 per month.

In exchange for that fee, we offer all of our members the primary care services they need most often, including physical exams, EKG testing, strep and urine testing, blood-thinner monitoring, minor surgical procedures, joint injections, and much more. Patients don’t pay a single penny more for these services beyond the cost of their membership fee.

Read the full op-ed at the Washington Examiner.



D4PCF on Hannity National Radio

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.


Dr. Gross Doesn’t Go To Washington

The stage was set to take the innovation of DPC (Direct Primary Care) to the halls of the Senate when the wheels came off with the drama of the Kavanaugh nomination hearings.

Testimony on health care innovation has been postponed in the wake of the last minute accusations swirling through Washington.

“One thing that is clear is that Washington only knows brinksmanship.  It is precisely that Washington obstruction mentality that has handcuffed small practice and driven them into near extinction.
Do we want that brinksmanship to be what guides our entire national health care system?  That’s what will happen if we adopt a government controlled single payer health care system.”

– Lee Gross, M.D., President of Docs 4 Patient Care Foundation.

Dr. Gross steps into The Doctor’s Lounge with host Mike Koriwchak to share some of the testimony he was scheduled to deliver to the Senate committee.


Part 1


Part 2


Part 3


Part 4


Protecting DPC from Washington’s Trojan Horse

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!

– Lee Gross, M.D.
President, Docs 4 Patient Care Foundation

Read the Amended Legislation HERE.

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.

Dr. Lee Gross filmed a video analysis in his weekly update from Epiphany Health well worth the time.
Watch HERE.