Tuesday, April 24, 2018

The Tapeworms are Hungry for Direct Primary Care






When Amazon, Berkshire Hathaway, and JP Morgan (AmBerGan) announced their healthcare partnership, Berkshire CEO Warren Buffett declared “the ballooning costs of healthcare act as a hungry tapeworm on the American economy."  He is right.  Our broken system is infested with tapeworms. Tapeworms are parasites; they exploit their hosts, drain resources, and suck the life out of their prey.  Unfortunately, Buffett failed to call attention to the tapeworms specifically --they are insurers, hospital conglomerates, pharmaceutical companies, and pharmacy benefit managers.  

As healthcare costs continue to skyrocket, Americans increasingly find themselves struggling to make ends meet.  Direct Primary Care (DPC) is a “tapeworm-free” medical concept whereby: 1) a periodic fee is charged for comprehensive primary care services, (2) the arrangement is free from billing through third parties, and (3) if additional fees are charged, those are less than the monthly fee.  Depending on age, fees range between $60-150 per month. Patients gain direct access to their physician coupled with unprecedented levels of affordability. 

DPC physicians provide protracted office visits, after-hours appointments for emergencies, and occasionally, even home visits.  DPC practices can dispense chronic medications at wholesale prices, perform basic procedures in-office, and when outside testing is necessary, these physicians can negotiate discounted “cash” prices on behalf of their patients.  This model goes a long way toward restoring the sacred relationship between a patient and their physician.  It is no wonder patients are leaving the health care system in droves.

The last obstacle facing expansion of the DPC practice model is their misclassification as an “insurance” product rather than a “healthcare” entity.  Legislation, known as the Primary Care Enhancement Act, already exists to repair this mistake and has 29 cosponsors.  H.R. 365/ S.R.1358 would allow for two things:  1.  Taxpayers participating in a DPC arrangement may qualify for an HSA plan and 2. HSA funds could be used for monthly fees for a DPC arrangement.  According to the Moran Company, this legislation is nearly “deficit neutral.” 

Why has this legislation floundered? Because corporate interests, like those of the Amazon group and CVS-Aetna, have left Congress a little dazed and confused.  Enter Capitated Primary Care (CPC) from stage left, an entirely different medical practice model, where a pre-negotiated rate is paid monthly by a third party for unlimited primary care services.  This model welcomes the third-party back with open arms.

To make things more confusing, the Centers for Medicare and Medicaid Services (CMS) jumped on the DPC bandwagon by introducing a “Direct Primary Care Prototype,” is anything but direct primary care.  The CMS concept requires physician enrollment in Medicare and submission of patient data to receive capitated payments of $90-120 per month.  This innovative model is certainly intriguing, but is another example of capitation, not DPC.  Data on capitated payment for healthcare services is equivocal at best, an indication that cost containment is difficult to achieve with third party involvement.   

Following CMS footsteps, the Amazon group hired Martin Levine, MD, a geriatrician formerly of Iora Health, a Boston-based CPC entity focused on providing comprehensive services for the over-65 crowd, indicating they may be intrigued by the CPC model as well. Corporate entities should not lose sight of the fact that Qliance and Turntable Health went bankrupt last year after offering team-based CPC services to the masses. 

Tapeworms represent third parties who have ingratiated themselves into the patient-physician relationship in the interest of the almighty dollar.  As the distance has grown between patients and physicians, costs have spiraled out of control.  By inviting extra layers of bureaucracy, CMS and other corporations are essentially slapping lipstick on the tapeworm and trying to make CPC look as attractive as Direct Primary Care, but that is an illusion.  Cost-containment can only be achieved by bringing the patient and physician in closer proximity and eliminating the tapeworm infestation currently sucking the life out of the healthcare system.



 

 






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