House Bill to Expand Direct Primary Care Wins AAFP Support

September 27, 2016 03:27 pm News Staff

(Editor's Note: This story was modified after publication to correct a statement about direct primary care practices that see Medicare beneficiaries.) The AAFP is applauding a House bill that would enable physicians who practice direct primary care (DPC) to see more patients by changing the tax code so the model is not treated as a health plan or insurance.

[Female doctor discussing test results with male patient]

Passage of the Primary Care Enhancement Act of 2016,( sponsored by Reps. Erik Paulsen, R-Minn., and Earl Blumenauer, D-Ore., would mean Medicare beneficiaries would not have to pay DPC fees out of pocket, as they do now. It also would allow patients to pay the fees using a health savings account (HSA) without incurring a tax penalty.

Currently, DPC fees are not eligible HSA expenses. DPC practices can see Medicare beneficiaries as long as the practice's retainer fee does not cover services already covered under Medicare. Those that do so are advised to contact a health care attorney familiar with retainer-based practice models to ensure there is no conflict with Medicare's regulation of concierge care delivery.

"The direct primary care model embodies the central principles of the patient-centered medical home and is, at its core, patient-centric," said (then) AAFP President Wanda Filer, M.D., M.B.A., of York, Pa., in a Sept. 13 statement supporting the bill. "It is a model of care that entirely eliminates fee-for-service, frees family physicians from insurance rules and allows them to focus entirely on patients' needs."

Three percent of AAFP members practice in a DPC setting. They typically have a lower patient volume but also lower expenses for administrative staff, and they report having more time to spend with patients.

DPC patients typically pay a monthly fee that covers primary care services in addition to allowing greater access to their physician by email or telephone. The AAFP supports the payment model as an alternative to the fee-for-service method.

The DPC model has taken hold among employers that want to offer health benefits other than expensive commercial health insurance. It also may be appealing to individuals who cannot afford high insurance premiums.

"Several studies have found DPC patients have better patient experience of care and improved clinical outcomes as they become more engaged in managing their own health care," Filer stated.

The AAFP also supported a companion bill introduced in 2015 by Sens. Bill Cassidy, R-La., and Maria Cantwell, D-Wash. The Senate bill differs slightly from the House version in that it includes a proposal to make the DPC model a CMS demonstration project within Medicare Part B.

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