Posted in Access to healthcare, American Exceptionalism, Consumer-Driven Health Care, Dependency, Direct-Pay Medicine, Direct-Pay Practice Models, Doctor-Patient Relationship, Economic Issues, Free Society, government incompetence, Government Regulations, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, News From Washington, DC & Related Shenanigans, Organizational structure, Patient Choice, Patient Safety, Patient-centered Care, Policy Issues, primary care, Quality, Technology, Telemedicine Trends, Third-Party Free Practices, Uncategorized

Shelter In-Place Care: Another “Box Checked” for the Value of Direct Primary Care

HEADLINE:

FCC Unveils COVID-19 Telehealth Program, Updates Connected Care Pilot

The Federal Communications Commission is using $200 million in funding from the CARES Act to launch a new program to help providers access the broadband resources they need to support telehealth programs.

Wow, the government has discovered remote digital technology medical care!  Although, maybe a little late. What would we do without those innovative minds in D.C. ?!?

But there’s a better solution that’s been up and running for more than a decade; private citizens being free to act and chose what services they value.  It is a solution which occurred organically when an innovative supply side acted to solve other people’s problems within a cooperative marketplace driven by mutual benefit.  It is called Direct Primary Care (DPC). And it is only possible because we still have some semblance of healthcare freedom within our society.  No thanks to Washington, D.C.

But step aside, the FCC with money to burn is coming to the rescue after COVID is already in full crisis mode.

The DPC Consumer Guide -- Now Available for office/clinic use and and an educational/marketing resource for your patients.Never mind that Direct Primary Care physicians have routinely integrated remote care technology platforms into their practices for a more than a decade.  And set aside the fact that revenue in a DPC business model doesn’t rely on office visits (the opposite of social distancing) to trigger a billable encounter, the claim against which is paid out of a grossly over-priced pre-paid 3rd party fund that we call health insurance.  Instead, the Direct Primary Care physician is paid to be available to solve problems, answer questions, triage illness/injury, provide treatment and advice via the most appropriate venue for each patient.

And last, no disrespect meant to the media outlet below for featuring this story.  They are just reporting the healthcare news, as is their mission.

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https://mhealthintelligence.com/news/fcc-unveils-covid-19-telehealth-program-updates-connected-care-pilot

Posted in Access to healthcare, advance-pricing, Consumer-Driven Health Care, Direct-Pay Medicine, Direct-Pay Practice Models, Doctor-Patient Relationship, Economic Issues, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, out-of-pocket costs, Patient Choice, Patient Compliance, Patient Safety, Patient-centered Care, Policy Issues, primary care, The Quadruple Aim, Third-Party Free Practices, Uncategorized, Wait times to see a doctor

More Patients Turning to ‘Direct Primary Care’ | Medscape

Christine Lehmann, MA

February 11, 2020

Having quick access to a primary care doctor 24/7 is very appealing to Mick Lowderman, 56, who is married with two children, ages 10 and 8. He pays a monthly membership fee to AtlasMD, a direct primary care practice in Wichita, KS.

Primary care is built on the long-term relationship between clinicians and patients. A 10- to 15-minute patient visit doesn’t support that relationship, Sullivan says.

When Kevin Boyd, 64, fell on his stairs in Wichita and broke three ribs, he didn’t go the emergency room. Instead, he called Umbehr, who told him to come to his office. He referred Boyd nearby for an X-ray and dispensed pain medications at his office. The total cost was $70.

In contrast, the first time Boyd fell and broke his ribs, he had Blue Cross Blue Shield and drove himself to the ER, where he saw the ER doctor, a radiologist for an MRI, and got shots for his pain. The total bill was $14,000, and he paid $2,600.

“I don’t put off care the way I used to because of the money I save,” says Boyd, who joined AtlasMD in 2015.
For his monthly membership fee of $75, Boyd gets several benefits, including unlimited 24/7 access to Umbehr by text, email, or phone, extended same- or next-day office visits, and free diagnostic tests and office procedures, such as EKGs, DEXA scans, and body fat analysis. If Boyd gets really sick and needs a house call, or if he needs a phone consult when traveling, those are also included in the fee.
Posted in Access to healthcare, Doctor-Patient Relationship, Healthcare financing, Medical Practice Models, Organizational structure, outcomes measurement, Patient Choice, Patient Safety, Policy Issues, Protocols, Uncategorized

How Chaos at Chain Pharmacies Is Putting Patients at Risk | New York Times

They struggle to fill prescriptions, give flu shots, tend the drive-through, answer phones, work the register, counsel patients and call doctors and insurance companies, they said — all the while racing to meet corporate performance metrics that they characterized as unreasonable and unsafe in an industry squeezed to do more with less.

“I am a danger to the public working for CVS,” one pharmacist wrote in an anonymous letter to the Texas State Board of Pharmacy in April.

“The amount of busywork we must do while verifying prescriptions is absolutely dangerous,” another wrote to the Pennsylvania board in February. “Mistakes are going to be made and the patients are going to be the ones suffering.”

Posted in Access to healthcare, Accountable Care Organizations, American Presidents, big government, Doctor-Patient Relationship, Economic Issues, Electronic Health Records, Health Insurance, Medical Costs, medical inflation, Medicare, Patient Safety, Policy Issues, Uncategorized

How Medicare Ruined American Healthcare | Medpage Today

Regarding the King-Anderson bill, the forerunner of Medicare, touted by JFK which eventually was defeated in the Senate…

“Edward Annis, MD, spoke eloquently to an empty Garden and to one of the biggest TV audiences of the times.

He explained directly to viewers: “This is not health care insurance … It will put government smack into your hospitals … deciding who gets in, who gets out, what they get, and what they don’t get. … This King-Anderson Bill is a cruel hoax and a delusion. … It will stand between the patient and his doctor. And it will serve as a forerunner of a different system of medicine for all Americans.”

In the late 1990s I asked Dr. Annis what was in the King-Anderson Bill that enabled him to predict in 1962 the insolvency of Medicare and the coming government takeover of healthcare. He replied with a smile, “Cost-plus financing. It was a license to steal.”

Indeed, Medicare ushered in unbridled spending for two decades before approaching insolvency.

But, as predicted by Dr. Annis, the system became insolvent by the early nineties… Hospitals and many providers became addicted to the easy money and abused the system. Why not? Cost-plus meant guaranteed profit.

Faced with Medicare insolvency, the insurance lobby persuaded Hillary Clinton to have secret meetings, without physician input.

Though Hillarycare never became law, the effort brought a sea change. Patients could no longer choose their doctor. Insurance companies now owned the patients. Participation in HMOs rose from 10% to 50%. Your doctor could no longer refer you to the best hospital or consultants if they were “out of network.” The doctor-patient bond had been successfully severed.

Medicare does not mandate who gets into hospitals, but it forces patients to get out by paying for only a limited number of days.

For the past two decades, hospitals have aggressively been buying up medical practices. The goal is to establish accountable care organizations (ACOs). Private practitioners are being elbowed out slowly but surely. General practitioners (GPs) cannot admit a patient to the hospital without “hospitalists” taking over. Hospital surgeons cannot refer to private surgeons, etc. Even the concierge model will be wiped out.

The Medicare approach to ACOs requires three things: 1) electronic medical records, 2) a “Quality Care Protocol,” and 3) a “Protocol for the Elimination of Non-Compliant Physicians.”

This is the ideal rationing system.

The computer will eventually dictate all allowed testing and treatments according to a “quality,” or more likely “cheapest way to do it,” protocol. Providers will ration according to the computer or they will fall into the “protocol for elimination of non-compliant physicians.”

In the new system, no one has a doctor. Doctors have a shift. The doctor you see on the morning shift has absolutely no responsibility for you when his/her shift is over or on a day off. A nurse practitioner takes the patient history and physical, further fractionating care. A system like this requires that all doctors are created equal. They are not.

Politicians and bean counters have never understood healthcare delivery. It was used and abused as a political tool.

No one listened to the warning of Dr. Annis. The AMA is often demonized by historians for opposition to Medicare, but it understood healthcare delivery and the destructive nature of cost-plus financing. I blossomed in the Golden Age of Medicine and bear witness to the fall.

Source: How Medicare Ruined American Healthcare | Medpage Today

Posted in Access to healthcare, Doctor-Patient Relations, Doctor-Patient Relationship, Independent Physicians, outcomes, outcomes measurement, Pain, Patient Choice, Patient Safety, Patient-centered Care, primary care, Quality, Sleep, Uncategorized

Sometimes You Just Gotta Treat It | A Country Doctor Writes:

cropped-p1020226_23987524005104569910.jpg
A Country Doctor Writes

Notes from a doctor with a laptop, a house call bag and a fountain pen

I thought to myself about how often specialists are in a position where they can simply declare “Not my department”, but primary care docs are then more or less obligated to pick up the ball again and do something.

Two weeks later, Red was a new man.

I’m sleeping through the night, and no pain”, he grinned.

I still don’t know exactly what this was, but it’s gone.

Sometimes you just gotta treat it.

https://acountrydoctorwrites.blog/2018/12/03/sometimes-you-just-gotta-treat-it/

Posted in Access to healthcare, Consumer-Driven Health Care, CPT billing, Direct-Pay Medicine, Direct-Pay Practice Models, Doctor-Patient Relationship, Economic Issues, Employer-Sponsored Health Plans, Government Regulations, Health Reimbursement Arrangement (HRA), Health Savings Accounts (HSA's), Healthcare financing, Individual Market, Large group insurance market, Medicaid, Medical Costs, Medical Practice Models, Medicare, Patient Choice, Patient-centered Care, Policy Issues, Portable Insurance, primary care, Protocols, Reforming Medicaid, Reforming Medicare, Tax Policy, Technology, third-party payments, Uncategorized

Trump’s New Vision for Health Care

Hats off to John C. Goodman again! His work in leading the effort for market-based healthcare reform over the past 4 decades, and highlighting the government’s role in the dysfunctional mess we labor in, is second to none.

This Forbes article lays out a most concise and accurate rendering of what healthcare has become and why…and what to do about it.

If you’re tired of the hearing healthcare pundits wax feverishly about their favorite villains and how more regulations are the answer; or if you’re just a novice starting to explore the Healthcare conundrum, Dr. Goodman’s work is required reading. I recommend starting here and then circling back to some of his earlier work. The book “PRICELESS” is a recommended next step!

https://www.forbes.com/sites/johngoodman/2019/01/14/trumps-new-vision-for-health-care/

Posted in Access to healthcare, Consumer-Driven Health Care, CPT billing, Direct-Pay Medicine, Direct-Pay Practice Models, Doctor-Patient Relationship, Economic Issues, Employee Benefits, Employer-Sponsored Health Plans, Health Insurance, Healthcare financing, Medical Costs, Medical Practice Models, Patient Choice, Patient-centered Care, primary care, Quality, The Triple Aim, Third-Party Free Practices, Uncategorized

DPC and Self-insured Employers: Lifestyle-friendly Care for the 21st Century

http://ushealthmedia.com/dpc-and-self-insured-employers-lifestyle-friendly-care-for-the-21st-century/

In a typical insurance-based practice, meaningful face-to-face time between doctor and patient is somewhere between 5-10 minutes. Interesting, but surprisingly, shorter visits tended to result in more prescriptions being written and less time trying to get to the root of clinical problems.  And prescribing is usually a poor surrogate for good counsel and reassurance.

“What do you get when you mix low overhead with high technology and wrap it around an excellent physician-patient relationship? You get an ideal medical practice – a practice model designed to enhance doctor-patient relationships, increase face-to-face time between doctors and patients, reduce physician workloads, instill patients with a sense of responsibility for their health and cut wasted dollars from the entire system.”

The quote above is NOT from a Direct pay doctor or advocate, even though it precisely describes the attributes of DPC.  The quote is from the American Association of Family Physicians: The Ideal Medical Practice Model: Improving Efficiency, Quality and the Doctor-Patient Relationship.  

Notice how many of the characteristics of the Ideal Medical Practice looks very similar to the characteristics of a typical Direct Primary Care practice.  The ability to provide exemplary service is a natural element that arises from Direct Primary Care and other direct-pay models.

This direct engagement, absent the complexities and barriers created by the third-party network billing apparatus, enables a level of lifestyle-friendly involvement that naturally leads to a more satisfactory patient-doctor relationship and potentially superior clinical outcomes.

It’s hard to argue with cheaper and better.

Source: DPC and Self-insured Employers: Lifestyle-friendly Care for the 21st Century

Posted in Access to healthcare, Affordable Care Act (ObamaCare), Direct-Pay Medicine, Doctor-Patient Relationship, Economic Issues, Employee Benefits, Employer-Sponsored Health Plans, Government Regulations, Health Insurance, Health Savings Accounts (HSA's), Healthcare financing, Patient Choice, Policy Issues, primary care, Tax Policy, Uncategorized

Congress and the IRS have stranded patients in SwampCare


Why can’t patients use their HSAs – supposedly their own money – to pay DPC fees? Because the IRS says they can’t. Not only that, if they have a DPC membership, they can’t even make a contribution to their HSA.

Congress was considering a simple bill to fix that – H.R. 365. But on the way to the House Ways and Means Committee, provisions were sneaked in, with very limited time to comment, and the bill number was changed to H.R. 6317. Some things from the Affordable Care Act (ACA) were inserted, along with provisions that independent DPC doctors said would favor huge corporate entities – purveyors of big-box medicine – that want to dominate the market. The government would micromanage what a DPC could or could not offer, based on the AMA’s copyrighted procedure codes, and cap the fee that the DPC could charge – not just the amount that could be paid from an HSA. It would allow only Direct Primary Care. It would not allow Direct Patient Care arrangements with specialists; for example, a direct-care agreement with an endocrinologist to manage diabetes would not qualify. Then the bill was incorporated into H.R. 6199, with some of the objectionable features removed, thanks to patients and doctors who spoke out. We’ll see what emerges from the sausage factory.

Read more at


 

https://mobile.wnd.com/2018/07/congress-and-the-irs-have-stranded-patients-in-swampcare/