One of the more interesting proposals that takes us full circle in how we access our primary care physician will soon be debated by the Legislature.
LB 817, introduced by Sen. Merv Riepe, creates the Direct Primary Care Agreement Act. Direct Primary Care (DPC) is a medical care delivery contract between a patient and a primary care practitioner (physician or licensed nurse practitioner). The patient-practitioner relationship generally includes an agreement where a patient pays a monthly retainer for unlimited office visits and a set scope of practice that spells out what services are included. Direct Primary Care enhances the patient-practitioner relationship.
Direct Primary Care is an innovative health care reform model which can improve access to medical care, reduce the use of emergency departments for non-emergent primary care use and reduce health care costs. Since office visits are free, people tend to visit their doctor sooner when they start to feel sick and thus treatment is cheaper and less patients require hospitalization. It is in the doctor’s best interest to spend a little extra time with a patient so that the correct diagnosis is made so the patient does not return for another office visit.
DPC practices exist in 42 states and currently 13 other states are considering legislation. Passage of LB 817 is to guarantee in statute that DPC is not insurance and does not function as a health plan.
Some of the benefits of a Direct Primary Care system include:
A free-market option in health care;
Happier practitioners (better work-life balance; connection with patients; no insurance to bill; keeping seasoned practitioners from retiring too early out of frustration because of the excessive staff time and paper work that is required with insurance, Medicare and Medicaid; revitalizing primary care as being very important; and encouraging medical students and residents to become primary-care physicians);
Happier patients (focus on prevention; monitoring of chronic conditions; improved patient-practitioner relationship); and
Better health outcomes (a DPC provider in Washington State reported reductions of 14 percent in emergency room visits, 60 percent in inpatient stays and 14 percent in specialist visits, for an average saving of over 19 percent per patient).
Opponents say DPC will result in fewer practitioners available to the public because the model leads to a reduced patient panel size per doctor. In Nebraska, this is especially concerning given the shortage of primary-care practitioners. Practitioners are not indentured servants and may elect to retire earlier than desired because the bureaucracy in medicine has provided too many challenges. Panel sizes may be smaller, but if DPC practitioners are able to improve their work-life balance, the net gain could be more practitioners available to serve for additional years.
LB 817 enables, not mandates, DPC. This will establish DPC in statute to ensure its long-term viability and provide consumer protection language. The legislation will seek to minimize regulation and be at no cost to the state.
I attended a presentation that a physician from Colorado gave this last December. With his practice he had around 50% of his patients on direct primary care contracts and the balance were traditional patients. His price for DPC was around $75 a month and included a tele-health option where he could, because of the personal relationship with his patients, diagnose and prescribe medicine using a smartphone while they were traveling anywhere in the world. Because he does not file any insurance claims on DPC patients he requires less staff time and doesn’t have to wait months for insurance claims to be settled. The patients are happy because they can always consult with the same caregivers. This could be a program for small businesses who want to offer an extra benefit to employees who may have extremely high out-of-pocket costs on their traditional insurance plans.