AAFP Backs Senate Bill Supporting Direct Primary Care

September 23, 2015 01:30 pm News Staff

As some primary care physicians make the shift from private insurance to the direct primary care (DPC) practice model, limitations on patient eligibility are slowing the model's growth.

[Female physician talking to female patient in exam room]

Now the AAFP is supporting the efforts of a federal legislator who is throwing his weight behind the new care model. Sen. Bill Cassidy, M.D., R-La., has introduced the Primary Care Enhancement Act of 2015,(www.congress.gov) which would make it easier for patients to select DPC as an option for their medical care.

The AAFP wrote a letter(2 page PDF) to Cassidy expressing support for the legislation because it enables patients to participate in DPC using their health savings accounts (HSAs). Patients cannot use HSAs to pay for premiums under existing tax law, which has precluded many from choosing the DPC model.

"This legislation removes a legal barrier that prevents patients with HSAs from entering into DPC arrangements with family physicians and other primary care providers," the letter reads. "The bill also provides an avenue for patients who have HSAs, as well as patients enrolled in Medicare, to more easily avail themselves of services through the DPC model."

The legislation calls for setting up a CMS demonstration project for practices that wish to participate. Medicare patients can obtain DPC services now, but they must pay the monthly fees out of pocket and can contract only with physicians who opt out of Medicare. If the legislation is enacted, CMS would establish an innovative project that would pay DPC medical home practices a "periodic fee" for treating Medicare Part B patients.

To participate in the demonstration project, DPC practices would have to meet performance targets established by Medicare. Qualifying practices would be required to offer enhanced services, including preventive care, wellness counseling, primary care, care coordination, appointments seven days a week, secure email and phone consultations, and 24/7 telephone access to consultations. If they failed to meet the targets for two consecutive years, they would be excluded from the initiative.

Physicians who are frustrated with insurers and patients who are seeking more time with a primary care physician are choosing the DPC model. Patients typically pay a monthly fee that covers most, if not all, primary care services, including clinical, consultations and lab work.

Some large employers in the service sector, such as the hotel industry, have chosen DPC as a way to provide health care for employees without having to pay large insurance premiums. Monthly fees can amount to less than a typical phone bill.

DPC practices usually have a smaller patient panel, and office staff do not have to spend time with insurance forms. With reduced overhead, many physicians can streamline their practice costs. Because some treatments are not covered by the monthly fee, physicians who adopt the DPC model advise patients to obtain a high-deductible policy to cover emergencies.

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