Direct primary care could resolve many of the underlying problems facing doctors and patients in government and private-sector third-party payment arrangements. It has the potential to provide better health care for patients, create a positive work environment for physicians, and reduce the growing economic burdens on doctors and patients caused by the prevailing trends in health policy, including implementation of the Affordable Care Act of 2010.
The question is not whether direct primary care should be allowed as part of the health system, but how to enable even more direct primary care practices to flourish.
In this, policymakers can play a powerful role.State Policy RecommendationsState legislators who want to see this innovative approach flourish should implement free-market policies so physicians can feel free to start a direct primary care practice without fear of its being outlawed or overregulated out of existence.
Specifically, they should:
Review, rewrite, or repeal any state law, rule, or regulation that inhibits the growth of direct primary care practices. For example, Maryland limits services in a given year to an annual physical exam, a follow-up visit, and a number of other visits. Such arbitrary restrictions should be removed.
Address insurance regulation and licensure issues. States that have not done so already should review, and amend as necessary, their laws governing insurance regulation and medical provider licensure so as to ensure that state laws do not create unnecessary impediments to the offering of direct primary care arrangements. In the vast majority of states, physicians remain uncertain about the potential legal complications they could face in operating a direct primary care practice. State lawmakers can easily end that uncertainty, thus enabling physicians to practice with relative confidence and freeing patients from anxiety about the security of their care.
Federal Policy Recommendations. Congress should also make reforms that clarify the status of direct primary care arrangements under the tax code and federal programs.
Specifically, Congress should:
Reform the federal tax code to allow direct primary care payment for services through health savings accounts. The tax code treats direct care membership as a form of insurance, inhibiting individuals from opening HSAs if they are also enrolled in a high-deductible insurance plan. Yet HSAs would be an advantageous way for more consumers to pay direct primary care fees, and Congress should amend the tax code to allow them to pay for direct primary care.
Establish federal rules allowing medical home services to include direct primary care arrangements. Current law allows direct primary care practices to be treated as medical home services if the practices meet certain requirements. HHS is responsible for setting these requirements but has not yet done so, effectively inhibiting direct primary care.
Change current law and allow Medicare patients to pay doctors directly outside of the traditional Medicare program. Congress should remove the balanced billing limitations that require physicians to drop out of Medicare for two years if they accept direct payment from Medicare beneficiaries.
Encourage states to enable Medicaid patients to pay doctors directly for routine medical services. Congress should ensure that states have the flexibility to allow for direct payment in Medicaid, perhaps through establishing Medicaid medical accounts.