Monday, April 21, 2014

Family Medicine: Insurance and/ or Direct Primary Care- Changing Times in Health Care

I'm getting excited at the way patients are discerning their role change in health care.  They are getting to know how the high deductible health insurance works.  It's like a discount card, not real insurance.  They're expected to pay up front for their medication and their visits until they meet the deductible amount, often $3000.

They don't yet know what they have to pay for labs with their discount.  They're surprised when they see the price of their medications.  After they get the first sticker shock, they shift into consumer mode, often rejecting one of the prescriptions at the pharmacy and seeking a less expensive medication.  If they have asthma and bronchitis, they are out of luck since the inhalers are really expensive.  If they have COPD and bronchitis, they may have a $6oo medication charge each month.

They pay their co-pay of $20-35 to us, but three to four weeks later, get the discounted bill for the rest of their physician and office procedure charges.  They may not pay this until they see it for the third time, "I thought I had insurance."

After two or three visits, they have it figured out.  We're all set until next January when it starts all over again.

Many people just decide to get a Direct Primary Care doctor in addition to having the insurance.  They get more time with the doctor, generally don't have as many outside of office charges or go to ER's as much. They have a higher chance of not reaching their deductible. They spend $750-900 for their membership, monthly and any visit fees plus labs for their Direct Primary Care physician.  (Half that for their children, but more for infants).           

What do you think about your insurance or Direct Primary Care?

Learn more about DPC at the DPC Ohio Unsummit II May 17 at the Garden Inn in Beavercreek, OH.  Unsummit

Sunday, April 13, 2014

Direct Primary Care: Legislative Example for States to Consider

REFERENCE TITLE: direct care plans; insurance; exemption



State of Arizona
Senate
Fifty-first Legislature
Second Regular Session
2014


SB 1404

Introduced by
Senator Ward


AN ACT

AMENDING TITLE 20, CHAPTER 1, ARTICLE 1, ARIZONA REVISED STATUTES, BY ADDING SECTION 20‑123; RELATING TO DIRECT PRIMARY CARE PROVIDER PLANS.


(TEXT OF BILL BEGINS ON NEXT PAGE)


Be it enacted by the Legislature of the State of Arizona:
Section 1.  Title 20, chapter 1, article 1, Arizona Revised Statutes, is amended by adding section 20-123, to read:
20-123.  Direct primary care provider; exemption from regulation; notice; definitions
A.  A DIRECT PRIMARY CARE PROVIDER PLAN DOES NOT CONSTITUTE THE TRANSACTION OF INSURANCE BUSINESS OR A HEALTH CARE SERVICES ORGANIZATION IN THIS STATE FOR THE PURPOSES OF REGULATION UNDER THIS TITLE.
B.  A DIRECT PRIMARY CARE PROVIDER PLAN MAY ARRANGE FOR PRIMARY HEALTH CARE FOR ENROLLEES IN THIS STATE.
C.  A DIRECT PRIMARY CARE PROVIDER PLAN MUST PROVIDE A WRITTEN DISCLAIMER ON OR ACCOMPANYING ALL APPLICATION AND GUIDELINE MATERIALS DISTRIBUTED BY OR ON BEHALF OF THE DIRECT PRIMARY CARE PROVIDER PLAN THAT READS, IN SUBSTANCE:
NOTICE:  THE ORGANIZATION FACILITATING THE DIRECT PRIMARY CARE PROVIDER PLAN IS NOT AN INSURANCE COMPANY AND THE DIRECT PRIMARY CARE COMPANY GUIDELINES AND PLAN OPERATION ARE NOT AN INSURANCE POLICY.  PARTICIPATION IN THE DIRECT PRIMARY CARE PROVIDER PLAN OR A SUBSCRIPTION TO ANY OF ITS DOCUMENTS SHOULD NOT BE CONSIDERED TO BE INSURANCE.  REGARDLESS OF WHETHER YOU RECEIVE TREATMENT FOR MEDICAL ISSUES THROUGH THE DIRECT PRIMARY CARE PROVIDER PLAN, YOU ARE ALWAYS PERSONALLY RESPONSIBLE FOR THE PAYMENT OF ANY ADDITIONAL MEDICAL EXPENSES YOU MAY INCUR.
D.  FOR THE PURPOSES OF THIS SECTION:
1.  "DIRECT PRIMARY CARE PROVIDER PLAN" MEANS A PRIMARY CARE PROVIDER THAT COLLECTS ON A PREPAID BASIS FEES TO CONDUCT PRIMARY HEALTH CARE FOR ENROLLEES.
2.  "ENROLLEE" MEANS AN INDIVIDUAL, FAMILY OR GROUP THAT HAS ENROLLED IN A DIRECT PRIMARY CARE PROVIDER PLAN.
3.  "PRIMARY CARE PROVIDER" MEANS A PHYSICIAN WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 13 OR 17 AND WHO SPECIALIZES OR IS BOARD CERTIFIED IN GENERAL PRACTICE, FAMILY MEDICINE, INTERNAL MEDICINE OR PEDIATRICS.
4.  "PRIMARY HEALTH CARE" MEANS CONDUCTING ALL COMPONENTS OF PRIMARY CARE THAT IS ORDERED AND SUPERVISED BY A PRIMARY CARE PROVIDER, INCLUDING MEDICAL VISITS, LABORATORY TESTING, IMAGING, PATHOLOGY TESTING, PRESCRIBING AND ADMINISTERING MEDICATION AND OTHER MEDICAL PROCEDURES THAT MAY BE PERFORMED OR SUPERVISED BY A PRIMARY CARE PROVIDER WITH TRAINING AND EXPERIENCE IN THAT PROCEDURE.

Tuesday, April 1, 2014

Measuring Quality in Direct Primary Care: Let Patients and Physicians Define it Together



One challenge with the DPC "solution" is the freedom enjoyed by the early adopters of the concept as they frame the potential for a dominant design.  There is still some radical innovation at the edges that should be allowed to play out before nailing down the center of DPC.  Honoring the sacred nature of the patient-physician relationship anchors the potential for personalized quality parameters that exceed some of the phony, but measurable, drivel currently being forced on family physicians and their patients (e.g.,statins for everyone who ever stayed at a Holiday Inn Express). 
While others, such as Harold Sox commented on the need for dyadic defined quality parameters in JAMA a couple years ago, complemented by more recent JAMA comments from Mayo Clinic echoing the same need,  Family Medicine has fallen behind in our responsibility to measure quality through dyad driven parameters, sometimes drooling over A1C's as Godly annointed quality truths while ignoring the beauty of the ongoing patient-physician relationship which has quality defining potential of radical proportions. 
Which is to say we should encourage presentation of DPC quality parameters that show the uniqueness of the model and its fans/ practitioners.  Human values manifested through pt-phys relationships into human outcomes could refresh some of the dullness of the EHR as well as patients and physicians.  This is what we do daily in Family Medicine and it's extremely satisfying.  With the time allowed in most DPC settings, it can continue, and improve.  Onward.

Sunday, March 23, 2014

#DirectPrimaryCare Ohio Unsummit II Coming Soon to Dayton



Direct Primary Care Ohio Unsummit II in Beavercreek (Dayton) May 17 at the Hilton Garden Inn.

We have two sessions for this Unsummit, one for those who need to learn about Direct Primary Care such as medical students, physicians, nurse practitioners, employers, patients, community leaders and health care leaders.  The rest of the day, in the second session, we focus on "Nuts and Bolts" of DPC for primary care physicians, primary care nurse practitioners, primary care physician assistants, medical administrators and medical office staff (and others such as medical students and residents).  Click on the link above for details of where, how and how much.

Our base group of "chronic" faculty are listed on the link to the agenda from the link above.  Other faculty will include an insurance expert discussing the availability of catastrophic health insurance in Ohio and the potential fit with Direct Primary Care (eventually?).

We will be online for a few parts of the agenda, reviewing DPC sites that represent different practice types and sizes.  The prices for all of the practices will be publicly displayed on those sites. This transparency is one of the hallmarks of DPC, but a point of controversy with some who have concerns about price fixing.  Nothing about this meeting is intended to fix prices for health care services.  On the contrary, the transparency of DPC is more protective of the public's interests where prices are concerned.

Other DPC physicians and administrators will have an opportunity to participate in person or via social media transmission into the conference room.  The low price of our unsummits enables more persons to participate, but impacts our ability to fly faculty in from a diverse array of DPC practices.

Thousands of physicians are involved in DPC.  It's a growing movement/ solution to overcome  much of what's problematic in health care today.  Stay tuned!

A DPC National Summit is scheduled for Washington, DC June 20-21.  DPC National Summit 2014


Friday, March 21, 2014

Brain, Pain or Vein Problems? MTHFR Methylation Flaw May Be the Cause


Guest Post by Lauren Miyamasu, RN, FNP Student WSU

Do you have “Brain, Pain, or Vein” problems? Eating plenty of leafy green and yellow vegetables can help clear up that foggy, forgetful brain, decrease those body aches and pains, and decrease the risk of heart attack, stroke, and pregnancy complications! But you need to have enough of the “right stuff” (aka an enzyme called “MTHFR”) to help process those veggies into useful forms! Some of us are lacking that enzyme. However, by supplementing with methyl folate and methyl B12 vitamins, we can help the problems!
Here are some links for more information on MTHFR: