Direct Primary Care and health savings accounts

The direct primary care (DPC) model has benefits for both independent physicians and their patients. DPC practices are run on membership fees, so there is less administrative work for the provider and fewer out-of-pocket costs for patients.

Some DPCs do accept insurance, primarily as a convenience for their patients and to cover procedures or hospitalizations that are not included in the membership fees. In the eyes of the Internal Revenue Service (IRS), however, the membership fees are themselves are not a form of insurance and so patients are not allowed to use Health Savings Accounts (HSAs) to pay those fees.

A bill has been introduced that would revise the IRS ruling. H.R.365 – Primary Care Enhancement Act of 2017 was introduced into the House in January 2017. The bill would amend the IRS code to “permit an individual to pay primary care service arrangement costs from a health savings account.”

In addition, H.R. 365 would “allow an eligible taxpayer enrolled in a high-deductible health plan to take a tax deduction for cash paid into a health savings account, even if the taxpayer is simultaneously enrolled in a primary care service arrangement.” The bill expands the definition of “medical care” to “include periodic provider fees paid to a primary care physician for a defined set of medical services provided on an as-needed basis.”

The bill was referred to the House Committee on Ways and Means on January 6, 2017, but no further action has been taken since.

DPCs enable independent physicians to more actively engage with their patients, as they generally see fewer patients and are less concerned with the paperwork involved in dealing with insurance companies. The independent physician in a DPC practice must balance the financial structure with the benefits involved for both provider and patients.

Elation Health is dedicated to helping DPC physicians succeed. We offer an electronic health record (EHR) system that aligns with the unique goals of a DPC practice. We have also just released our Direct Care Playbook, written specifically to help independent physicians in a DPC launch and sustain a successful practice.

Gabby Marquez
July 31, 2017

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What are the first steps to take for starting a DPC practice?

The direct primary care (DPC) model is enticing to many independent physicians. The number of DPC practices continues to grow, with the lure of reduced administrative burden and increased patient interaction time. Independent physicians who decide to practice under the DPC model may be starting completely new practices or transforming an existing traditional practice. Either way, there are some steps that should be taken when starting a DPC practice.

The American Academy of Family Physicians (AAFP) recommends that the independent physician with an existing practice should conduct “a practice evaluation to determine whether the practice would benefit from transforming into a DPC practice.” Once that is done, the AAFP recommends consulting a legal expert familiar with DPCs who can provide “insight about local and state regulations governing the practice of retainer-based medicine and whether current insurance carrier contracts may be amendable to complementary services covered under a retainer fee.”

Elation Health has developed a Direct Care Playbook that outlines steps that need to be taken by a physician considering launching a new DPC practice.  Some considerations include:

  • Finding an office. The physician will need to determine whether it is more feasible to rent or buy office space. The office will also need to have equipment and furniture. All of these steps will take time, generally about six months.
  • Staffing. With the DPC structure, the number of staff required to manage the practice is significantly reduced but the physician will probably need one or two assistants for the practice.
  • Pricing guide. Since a DPC practice operates primarily on patient membership fees, DPC physicians need to decide how much they need to make to keep their practice afloat, and how much they would like to make in an ideal situation.

The DPC physician will also need reliable technology to maintain patient records. The electronic health record (EHR) is a critical first choice for any physician starting a direct care practice. This tool will be the main technology a physician engages with throughout the day, keeping workflows efficient and informing decisions at the point of care.

Austin De La Ossa
July 31, 2017

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Legal tips for direct primary care practices

A direct primary care (DPC) practice operates differently than a traditional independent provider’s practice, in regard to how it affects both the patient and the physician. A DPC practice, at first glance, appears to have a relatively simple model. The practice receives monthly membership fees from patients rather than charging for each visit. These membership fees cover basic primary care services and may, depending on the practice, also cover a number of coordinated care and off-site laboratory or diagnostic services.

The idea behind DPC is that physicians are able to spend more time with their patients and less time worrying about billing, insurance, and practice management. DPCs may or may not accept insurance. Those who do, bill the insurance company as a convenience for their patients or to cover services and procedures not included in their monthly fees. Some also accept Medicare payments. That is where the simple idea behind the DPC starts to get a little more complicated.

However, physicians practicing under any type of DPC model, hybrid or not, do have some legal considerations. The American Academy of Family Physicians (AAFP) recommends consulting with an attorney familiar with the DPC model who can provide “insight about local and state regulations governing the practice of retainer-based medicine and whether current insurance carrier contracts may be amendable to complementary services covered under a retainer fee.”

Elation’s Direct Care Playbook offers some helpful legal tips for DPC practices as well.

  • Review and secure appropriate malpractice insurance. Independent physicians who move to a DPC model may be able to save money on malpractice insurance. DPC physicians tend to have fewer claims than regular physicians, so they can receive a nearly 50% discount on the cost of their malpractice insurance. With significantly lower malpractice premiums, direct care physicians can more easily obtain such insurance to protect their practices against potentially damaging lawsuits.
  • Review IRS regulations and definitions. Currently, the DPC practice patient fee is not a qualified HSA expense. Likewise, even though Medicare patients are the nation’s highest utilizers of care, most are unable to receive direct care, unless they receive coverage under a Medicare Managed Care Plan.

Elation also strongly recommends that the DPC practice consult a lawyer to ensure that the physician is up to date on the latest policies and procedures that affect the practice as well as the patients.

Greg Miller
July 31, 2017

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Building a website for your direct primary care (DPC) practice

As a direct primary care (DPC) physician, your focus is on taking care of your patients during their visits to your office. To grow your practice, you will also need a way to reach out to potential patients. As a DPC provider concerned with your patients’ health and well-being, you may also want to find a way to continuously educate them about your practice and about healthcare in general. A website can do all these things for your practice.

Establishing an online presence through a professionally designed and maintained website can help your practice build credibility and provide information in an accessible format. In particular, a well-designed and responsive website will help your practice stand out from the crowd. Here are some key elements your website should include:

  • Contact page with location and hours of operation
  • About us page to tell your story
  • Testimonials to showcase the care you provide
  • Practice blog to help attract new patients
  • Services page to communicate what you offer

As a DPC with standard monthly fees, you might also decide to post those fees on your website. All of these pages should contain specific keywords that will attract search engines and attract those patients who are searching for the types of services you offer.

Your site should be compatible with mobile devices, as most of the younger generations, millennials and Gen Zers, as well as a number of older Boomers, depend on their cellphones and other electronic devices for accessing important information. Search engines are also more likely to rank a mobile-friendly site higher.

Likewise, your website needs to be easy to navigate so visitors can find the information they need quickly and effortlessly. A website needs to engage patients with pertinent and current information about your practice and about healthcare topics in general, in order to attract new patients and to keep current patients educated.

Austin De La Ossa
July 28, 2017

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5 new direct primary care clinics to look out for

Direct primary care (DPC) practices are on the rise, with a number of independent physicians realizing they want to spend more time with their patients and less time billing insurance companies. The DPC model typically charges patients monthly fees, rather than fees for each visit, and they generally do not work with insurance companies. The patient receives services from the primary care provider, including virtually round-the-clock communications access and occasionally house calls, for their monthly payment.

Five new DPC clinics have sprung up from the providers’ desire to focus more on patient outcomes than on administrative tasks.

Dr. Dhillip Olshausen, in Medford, Oregon, says that “direct primary care allows the doctor to be a doctor again.” He is transitioning his traditional practice, in which he estimates he and his staff spent 50% of their time on administration, to a DPC in July 2017. He, his staff, and his patients are looking forward to developing a closer patient-provider relationship as he focuses more on healthcare delivery and less on paperwork.

Iora Health intends to collect its DPC fee from employers for a new form of healthcare coverage for their employees. Iora has entered into a contract with UniCare in the state of Massachusetts, which will “pay Iora a monthly amount per-member, ultimately lowering the bill for the state by caring for patients on a budget.”

Gold Standard Pediatrics launched in South Carolina in late 2016, “with the singular focus of providing the highest quality personalized medical care for children.” Gold Standard’s goals are to help families find affordable, quality care for their children.

In Alabama, Dr. M. Chad Williamson recently opened his DPC practice to spend more time with patients and less time with insurance companies. His pricing is listed on the practice’s website and includes discounts for military, police officers, and firefighters. Dr. Williamson also offers a membership rate of $1 annually to patients aged 100 and above!

Making the move to a DPC practice from a large medical group last year, Dr. David Cunningham launched Infinity Family Care in Mansfield, Massachusetts. Dr. Cunningham offers a special membership plan for home-bound patients, setting his practice apart from the traditional office-bound independent physician.

Gabby Marquez
July 27, 2017

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Tips for staffing for DPC practices

Direct primary care (DPC) practices typically see fewer patients than a traditional practice. A DPC usually also opts to not accept patient insurance. As a result, overhead for a DPC is significantly reduced, overhead that includes staff members. When the practice does not bill per visit or bill for insurance reimbursement, there is less need for people to perform these duties. The DPC does bill for monthly membership fees but will generally not require the typical fully staffed office found in an independent physician’s practice.

A DPC physician who wants to attract staff to the practice should keep a few things in mind. With a smaller staff, it is even more important that the people working in the practice are able to work as a team. Owen Dahl, writing in Physicians Practice, suggests that potential staff should be evaluated based on three factors:

  • Knowledge. A DPC’s staff must be knowledgeable not only of how the DPC practice operates, but may also need medical knowledge, to be able to assist the primary care provider with patient engagement and care.
  • Skills. Although there is less to do in regard to billing in a DPC practice, there is still a need for effective practice management. Staff members must have the skills to manage appointments as well as patient membership fees.
  • Attitude. In a small office setting, such as that found in a DPC, the staff’s attitude toward the practice, toward the patient, and toward each other can make a significant difference in the patient’s experience. Staff must be able to communicate effectively with everyone involved with the practice, especially the patients.

Dahl also writes that by 2020, about half of the workforce will be millennials, those employees currently in their mid to late 20s. When staffing the DPC practice, the independent physician must keep in mind that the “mindset of these employees is built around learning, involvement, and participation in the organization,” so putting a plan into place that enables this new workforce to grow and develop their own skills will prove beneficial as well.

Greg Miller
July 20, 2017

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Social Media for Direct Primary Care physicians

Direct Primary Care (DPC) physicians can use a number of marketing tools for promoting their practice and for educating patients. DPC is a relatively new concept and a DPC practice may need to clarify some information or provide additional details regarding the way the practice operates, to reassure potential and current patients. Social media can be an effective platform for reaching those patients.

Millennials and Gen Zers, those patients in their mid to late 20s and younger, use social media as their primary means of gathering and sharing information. As millennials are approaching their 30s, they are getting married and starting families. A DPC practice that wants to attract this younger and largest generation of patients will need to have a solid social media presence.

Care must be taken when implementing a social media strategy. Online posts can take on a life of their own, with shares and reposts. A DPC’s messages must be professional and appropriate. When initiating online communication where patient information may be at risk, physicians should carefully avoid any HIPAA violations.

Sensitive situations include posting images of patients without their consent, compromising patient confidentiality by posting identifying information, and communicating with patients via a social media platform. DPC physicians should make use of their electronic health record EHR capabilities when communicating with patients, to ensure that any information transmitted is secure.

Social media can reach a large number of people with just one post, but that one post requires careful planning and a bit of effort on the DPC’s part. A staff person may be assigned to post timely, relevant content and to respond to comments. For example, a DPC practice may decide to build a Facebook page that will require timely and consistent monitoring. These social media options do provide the DPC with an effective outlet for education and marketing, as long as they are planned and maintained in a manner that is engaging and professional.

Gabby Marquez
July 18, 2017

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5 reasons why patients love direct primary care

Direct Primary Care (DPC) is growing in popularity with primary care physicians. Under the DPC model, billing is virtually eliminated as patients pay a monthly membership fee rather than paying per visit. Physicians are also able to spend more time with fewer patients in a day as a DPC, given that their income is based on the monthly fee and not on the number of patients they see.

Patients also have a number of reasons they cite as to why they love the DPC model. A recent blog post in Twine Health lists four of those reasons:

-Less expensive. Patients pay a monthly fee instead of paying a copay or full fee at each visit. Insurance copays can add up when a patient has multiple primary care visits within a month’s time. With a DPC, there is only one payment per month and that is usually low, typically in the $25-$85 range.

-More convenient. A patient can generally make an appointment sooner and receive more services than with the typical primary care physician model. Patients have more access to the physician during the visit as well as through communication in between visits.

-More effective. In a DPC model, patients become more engaged in their own healthcare. The primary care physician is not just there to send patients to other providers, but is able to offer more “coordinated and continuous” care, an aspect particularly important to patients with chronic or complex illnesses.

-More personal. Primary care physicians who operate under the DPC model see fewer patients per day and so are able to spend much more time with each patient. Their patient engagement increases, as does the patient’s satisfaction with the level of care received.

A recent article in the Wall Street Journal adds a fifth reason why patients love direct primary care. In a DPC model, patients “can provide their own quality control.” If the model or the practice does not work for them, they can leave. The WSJ adds that, so far, “satisfaction rates run high.”

Greg Miller
July 17, 2017

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What the research says about Direct Primary Care

Direct Primary Care (DPC) is an innovative practice model that enables the independent physician to spend more time with patients and less time with billing paperwork. In a DPC practice, patients pay a regular monthly fee for services. The primary care physician does not bill the patient or an insurance company for each visit. While a relatively small percentage of physicians practice as DPCs, the model is growing in popularity and has support from organizations such as the American Academy of Family Physicians (AAFP).

The AAFP cites research that shows that “DPC patients have better patient experience of care and improved clinical outcomes as they become more engaged in managing their own health care.” In the DPC model, patients have predictable costs as they pay a monthly membership fee that covers their primary care physician visits, lab tests, and communication with the physician beyond the office visits.

The Wall Street Journal reports that physicians who operate as DPCs “say the steady income from membership fees frees them from having to pack patients into 10-minute visits to make ends meet.” They are able to focus more on patient engagement while the patient is in the office as well as “handle many issues via text or email, which are rarely reimbursed in traditional fee-for-service medicine.”

According to the WSJ, research also shows that the DPC model “may work particularly well for patients with complex medical conditions who need careful monitoring and help coordinating multiple specialists.” A patient with a chronic or complex illness may need to visit the primary care physician multiple times each month, all of which would be covered under a single membership fee.

As there is still a small percentage of physicians operating as DPCs, there is little research available as to whether the model actually helps improve patient outcomes. As DPC grows, however, it’s likely that researchers will be more interested in studying how the model impacts access to care, care quality, and healthcare costs.

Gabby Marquez
July 13, 2017

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Concierge Medicine vs. Direct Primary Care

Healthcare delivery comes in many forms. The traditional independent primary care physician model, in which physicians see a number of patients each day and then bills insurance companies for their services, is somewhat transforming. Over the past couple of decades, two new models have risen in popularity: concierge medicine and direct primary care (DPC). While there are some similarities in the two, there are also a number of differences.

Both the concierge and the DPC models have as their core a membership fee paid by the patient, or sometimes the patient’s employer. Concierge practices may also bill the patient’s insurance company for covered services, while the DPC practice usually relies solely on the membership fees to cover costs.

Membership fees provide direct access to physicians in both models. When the physician is not relying solely on insurance reimbursements to finance the practice, the number of patients seen each day can be reduced, so the physician has more time to spend with each patient. In the concierge model, the membership fees may be slightly higher and the patients may receive increased access to their physician’s services.

A study cited by the AAFP and conducted by the Concierge Medicine Research Collective found that “people age 50 and older make up an increasing share of patients at most concierge practices.” Typically, these concierge services are more concentrated in states such as California and Florida, which have higher populations of patients over age 50.

Those concierge practices seeing Medicare patients or that are billing insurance companies in addition to the membership fee are subject to the relevant rules and regulations. DPC models that do not bill insurance are not subject to Medicare or insurance regulations. The DPC model is identified in the Affordable Care Act as an acceptable non-insurance option, but the concierge model is not.

In both models, patients enjoy the individual attention and communication they receive from their physicians. Physicians are better able to focus on patient care with fewer worries about practice management issues. An independent physician considering a transition to either model will need to weigh all of the pros and cons for the practice and for the patient before moving forward.

Greg Miller
July 10, 2017

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