Many years ago, healthcare seemed much simpler. A patient saw a doctor, paid the doctor in cash (or made payment arrangements), and that was the end of the financial transaction. In the 1940s, just after the second World War, third party insurance companies came onto the scene, bringing with them paperwork and reimbursements and an array of complexities. Approximately 50 years later, in the late 1990s, a new form of medical care emerged that closely resembled the simpler model from years ago.
Direct primary care (DPC) operates on a relatively straightforward model of patient membership fees. Most DPCs do not accept insurance for primary care services but do recommend that patients carry high deductible insurance for services that are not covered by their membership fees. At that point, the complexity re-emerges in regard to current regulations and policies.
At present, DPC patients are not eligible for health savings accounts (HSAs). An HSA allows the patient to set aside money, pre-tax, that can be used for healthcare expenses. The account helps patients save for medical expenses, on a pre-tax basis, that would be part of their high deductible insurance policies.
A bill has been introduced that 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.” However, no action has been taken on the bill to date.
In addition, DPC physicians have said that “they’d prefer to recommend catastrophic health insurance plans, which have deductibles as much as $10,000 or $30,000 and aren’t allowed under the ACA.” Discussions around proposed replacement healthcare plans may take into consideration these policy recommendations, but that is uncertain at this time.
Updating policies and regulations that impact DPC physicians and their patients, to enable them to take advantage of the simplicity and efficiencies the DPC model has to offer, would certainly also enable the direct care practice to flourish.