How to Protect and Enhance Direct Medical Care, and Not Diminish It

The following is a guest blog entry from Dr. Kim Corba, a board-certified family physician and the owner of Green Hills Direct Family Care and an advocate for health reforms that put patients first.

You or a loved one is ill.  You’re not sure what is going on, but you would like an appointment with a physician.  You have a busy day ahead. You call your doctor’s office and have to leave a message. Will you get a call back before 12 noon?  What other choices do you have for yourself or loved one--Urgent Care, ER, Telemedicine--with your $5K+ deductible?  You shudder at the thought of the cost and feel like you have little to no control of the situation.

So, what do Americans do in situations like this?  They roll up their sleeves and look for an alternative process, especially when what isn’t working costs a lot of money and is inefficient!

There is a quickly expanding model of healthcare delivery called Direct Primary Care (DPC) and it is disrupting the status quo. As a grassroots physician-led medical movement which exists outside of insurance, it is providing patients with increased access, attention and affordability in over 1000 practices across the country.  DPC is a subscription model (think Netflix or Costco) that charges a monthly affordable fee for a wide range of primary care services. It removes the red tape of insurers and eliminates the middlemen from the exam room which lowers business overhead and allows the savings to be passed onto the patient. The majority of Direct Primary Care offices are independent, small practices. This link will provide a typical description of the extensive list of valued services. 

It is very exciting to see that specialists are also opening direct care practices. Having specialists offer discounted direct care pricing will help to expand choices for patients even more.

American consumers want the ability to choose how, where and when to spend their health care dollars. DPC patients can do all of the above because DPC works nicely with Employer-Sponsored Plans, Health Reimbursement Arrangements (HRAs), Health Sharing Plans (HSPs), and Short-Term Limited Duration Insurance (STLDI).  Patients with Health Savings Accounts (HSAs) paired with High Deductible Health Plans (HDHPs) would like to use DPCs for affordable routine care and depend on the HDHP to cover catastrophic care.  In fact, many do just that.

Unfortunately, the Department of Treasury has been vague as to whether HSA owners can have a DPC relationship and still contribute to an HSA or to use the funds to pay the DPC fees. HSA reform is needed to clarify that both are allowed.  However, the HSA bill, “The Primary Care Enhancement Act” (HR 3708), will NOT define this authorization, but will, instead, threaten patients’ ability to enjoy the valued benefits of Direct Primary Care if paying with an HSA. Independent DPC offices are providing the most value-added services for their cost but would be hindered by this bill.  Maybe HR 3708 should be renamed “The Primary Care Diminishment Act.”

In a move to be the first law to restrict the maximum allowable amount of personal HSA funds that can be used to pay for an allowable medical service, HR 3708 proposes a cap on DPC spending.  The proposed $150 monthly cap may seem generous but not if a patient has a primary care and a specialist who both operate a direct care practice?  This cap could apply to a sum-total of direct care fees which could exceed the $150/month limit.  Additionally, HR 3708 could set legal precedent for future caps on HSA fees for other medical services.  Can you say, “slippery slope?”  What medical services could be capped next, contact lenses, physical therapy or counselling services? The cap on annual HSA contributions is sufficient.  An attempt to cap any particular medical expense should be eliminated from legislative efforts.

This bill also restricts and removes patients’ choice to use personal HSA funds for specialty direct care. HSA dollars should be allowed to be used for a direct pay Gynecologist, Cardiologist, Psychiatrist, etc.  Imagine direct pay Neurology for Alzheimer’s or Parkinson’s--or direct pay Psychiatry for Autism or Addiction.  Why would lawmakers want to exclude other affordable alternatives? HSA legislation should not have any restriction on the use of HSA dollars for specialty direct pay services.

A HUGE value-add to DPC services is the ability of DPC physicians to dispense generic meds directly from their offices at near-wholesale prices. Some offices bundle meds into the periodic medical fee.  Here is a link to my office’s generic pricing that includes the transparent 10% mark up for labels, bottles and labor. HR 3708 contains unclear language that would restrict the ability for independent DPC offices to continue to offer this affordable service to patients

HR 3708 also excludes the use of general anesthesia and some laboratory services (DPC offers negotiated deeply discounted labs too).

There are larger HSA reform efforts under way in Congress that include simple, clean language and would allow for DPC to be paid for using a Health Savings Account. Period. There are no added provisions or restrictions for such use in these other bills.  As a stand-alone bill, laden with regulatory restrictions (in a de-regulatory environment) and the resulting controversy surrounding this toxic language, HR 3708 only serves the purpose of interfering with more productive, comprehensive HSA legislation that will bring increased choice and value to patients.  Because there are so many points of concern written into this bill that will negatively affect patients, lawmakers should abandon HR 3708. If there must be a stand-alone bill, then keep the name but replace HR 3708 with the original "Primary Care Enhancement Act," HR 365 (115th Congress 2017-2018), which simply authorizes that HSA funds may be used to pay for DPC.

Wouldn’t you like to have the choice to use your HSA dollars without restrictions to obtain a medical service that will ensure you or your loved one has access and attention for a concerning illness? Don’t forget about the valuable, transparent and affordable prices and discounts.  Sounds wonderful…and you can keep your busy day as on track as possible.  I can’t think of a better way to use those HSA dollars. #StopHR3708



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