This testimony on Direct Primary Care was prepared for delivery to the Georgia House Insurance Committee on March 20, 2017. The legislation, S.B. 50, was presented by Senator Hunter Hill (Watch from the 53-minute mark at https://livestream.com/accounts/19771805/events/6811883/videos/152225554)
By Benita M. Dodd, Vice President, Georgia Public Policy Foundation
The Georgia Public Policy Foundation understands the challenges lawmakers face in extending access to health care for the impoverished as well as those living in Georgia’s rural areas.
We believe one way to address this is through an exciting, well tested approach: Direct Primary Care, which provides access, quality and control and an affordable monthly rate.
The Foundation has highlighted physicians practicing this approach in 2014, both at a May Leadership Breakfast with Dr. Lee Gross of Florida-based Epiphany Health (http://www.epiphanyhealth.org/) and at the 2014 Georgia Legislative Policy Forum with Dr. Josh Umbehr of Wichita-based AtlasMD (http://atlas.md/wichita/about-us/), who has been featured several times this month on Fox News and the Sean Hannity Show. Dr. Gross has had his practice since 2010, Dr. Umbehr for six years.
Here’s how Direct Primary Care works:
- The Direct Primary Care system eliminates the middleman. Instead of dealing with complicated insurance forms and rules, individuals take personal responsibility for their health care and deal directly with the physician/practice for a simple, manageable experience.
- Much like a gym membership, individuals pay a monthly fee for access to expert physicians, averaging $40 to $80.
- Because individuals get to know their doctors – they have a medical home – they are assured their health care concerns will be heard and they receive care, not just coverage.
- Direct Primary Care addresses the rising costs of health care with transparency: Costs for procedures beyond those covered by the membership are clearly outlined, therefore predictable. Some surgical procedures are one-sixth to one-tenth the cost of a typical hospital charge.
This approach helps in providing greater access to quality care for all Georgians, not just expensive insurance coverage for some.
The American Academy of Family Physicians supports this approach as well. John Meigs, the academy president, said of physicians, “you’re not on the hamster wheel of getting paid based on the volume you do. Patient satisfaction goes up. Physician satisfaction goes up. Quality goes up and costs go down because you don’t have to prove it to Uncle Sam or an insurance company.”
Direct Primary Care’s popularity is growing. There are more than 500 practices across the nation, and at least 15 in Georgia, according to the Direct Primary Care Journal. Currently, IRS rules prohibit using funds from Health Savings Accounts to pay direct-care membership fees, but legislation to allow this has been introduced in both the U.S. House and Senate.
Direct Primary Care provides a medical home beyond the Emergency Room for patients with chronic ailments. While a patient would obtain a high-deductible, low-cost catastrophic insurance policy, the Direct Primary Care practice becomes the place they can go to address up to 90 percent of their health care needs.
To operate without costly regulatory and administrative hurdles that can add up to 60 percent to physicians’ costs, however, these practices need assurance that the approach is defined as a health care service, not an insurance plan subject to state insurance regulations. Practitioners need the reassurance they can continue to safely practice. New providers need assurances that they are welcome to begin practicing in the state. We hope Georgia will join the states that have already defined Direct Primary Care as outside the scope of insurance.
We believe it is time for legislators to empower Georgians to reclaim control over their health care decisions. Georgia families deserve the opportunity to make their own health care decisions unencumbered by bureaucratic hurdles. Georgia’s patients deserve to be back in the driver’s seat. Georgians living on fixed or low incomes deserve access to high-quality care, unhurried by physicians forced to meet their bottom lines through an assembly-line practice.
To paraphrase the Heritage Foundation, “Let’s free up primary care docs to further improve their quality, access and patient-centered services – not their billing savvy.”
States with DPC laws as of June 2016:
- Washington –48-150 RCW
- Utah –UT 31A-4-106.5
- Oregon –ORS 735.500
- West Virginia –WV-16-2J-1
- Arizona –AZ 20-123
- Louisiana –LA Act 867
- Michigan –PA-0522-14
- Mississippi –SB 2687
- Idaho –SB 1062
- Oklahoma –SB 560
- Missouri –HB 769
- Kansas –HB 2225
- Texas –HB 1945
- Nebraska – Bill 817
- Tennessee –SB 2443
- Wyoming –SF0049
 Wall Street Journal, February 27, 2017, “With Direct Primary Care, It’s Just Doctor and Patient.” https://www.wsj.com/articles/with-direct-primary-care-its-just-doctor-and-patient-1488164702