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The ‘Marshall Plan’ to Save Primary Care

Primary care physicians are facing challenges that threaten their very existence, and despite pivoting to virtual health and making other changes, they face a massive drop in volume and revenue. As a result of the financial cliff, some physicians are pushing for a new way to pay for primary care.

“I am convinced that when we get on the other side of the pandemic, the care delivery system is fundamentally going to change, but it is going to be a really painful trip getting through the pandemic,” says Tom Banning, Texas Academy of Family Physicians CEO, who has been working on what he calls a “Marshall Plan” to save primary care. 

Dallas-based Merritt Hawkins surveyed physicians and found that 21 percent of physicians have been furloughed or experienced a pay cut, 14 percent plan to change practice settings as a result of COVID-19, 18 percent plan to retire, temporarily close their practices, or opt out of patient care, and 16 percent have or will cut reduce staff. Around one-third of physicians (32% percent) said that they will change practice settings, leave patient care roles, temporarily shut their practices or retire in response to COVID-19.  

Read the full article at D Magazine

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Primary care needs a new operating system

Primary care was meant to be the front door to the healthcare system: the one-stop-shop we rely on for all of our general healthcare needs, and to help us navigate the rest of the convoluted care delivery ecosystem.

But as a front door, it’s pretty broken.

The impact of COVID-19 has shown us this more than ever before—primary care’s already overburdened system has crumbled under the pressure, with patients left to self-diagnose without lab tests or in-person visits, wait in eternal telephone queues for callbacks that may or may not happen. In short, the very place in the healthcare system that was supposed to help catch illness soonest, in fact, created barriers.

The truth is, though, it may have never been set up for success in the first place, given its extremely broad mandate.

Just consider the number of billing codes primary care has to manage: more than five times the number of billing codes (the mix of services that can be billed for and reimbursed through insurance) than the next specialty. Despite the fact that primary care physicians (PCPs) are the ones handling the vast majority of visit volume (52% of ~1B annual outpatient visits), primary care has been both underappreciated and under-compensated—only 5%-8% of overall healthcare spend (PDF), and the lowest annual income amongst all specialties (PDF).

Read the full article at Fierce Healthcare

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COVID-19 shows Direct Primary Care model’s strengths

As a family physician for R-Health Yardley, I am fortunate to be able to stay connected to my patients as we navigate and adjust to the current changes our community is facing. As a Direct Primary Care Provider, I am proud to be there for my patients, helping ease their anxieties as they cope with the concerns of COVID-19 and what it means for them and their families.

Direct Primary Care is an alternative to traditional primary care. It is a model that truly focuses on the patient-physician relationship and has been proven to promote positive health outcomes. Individuals who receive this type of healthcare, whether it is offered through their employer or they chose to enroll on their own for a flat monthly fee, have access to unique care opportunities. Direct Primary Care offers the same general medical care and chronic disease management but with so much more than what traditional primary care can offer. Our offices offer onsite labs and immunizations and coordinate care with specialists. However, the real benefits of Direct Primary Care are what make us unique. Our patients have little to no wait time for an appointment and we usually see them same day if needed. As a physician, I am not pressured to see a certain number of patients a day and don’t have an overwhelming stack of paperwork or billing to complete. This leaves me with more time to connect with my patients, getting to know them and listening to all their concerns.

Read the full article at The Intelligencer

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How COVID-19 Is Changing The Debate Over Health Reform

A revolution is occurring in the way medical care is being delivered in the United States. It is happening almost overnight.

People have stopped going to hospital emergency rooms. They have stopped going to doctors’ offices. Most of the nation is self-isolating. Doctors and patients are no exception.

They are communicating by means of phone, email, Skype, Zoom and other devices. Last December, Zoom was the host of 10 million video conferences a day. Last week, the company was hosting 200 million a day. Many of those were patient/doctor communications.

If you are like a great many people, you are probably wondering why it took so long.

Answer: government.

Read the full article on Forbes

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How Direct Primary Care shines a light during pandemic

In our previous piece, we discussed how the lack of price transparency in the American healthcare system has become an addictive painkiller — the “opiate of the masses.” Protection from the pain of prices that are hidden (opaque) dulls our thinking just enough so that we don’t get too worked up.

There’s a different model for the practice of medicine that is gaining increasing support among physicians and patients.

Direct Primary Care (DPC) is a timely subject because physicians using this model are among the best equipped, best prepared, and most effective on the front lines of the fight against the pandemic.

Pennsylvania is the first state to begin educating the general public, business groups, and medical schools about this model, and the first state to receive a grant from its medical society for that purpose. But DPC practices are springing up all over the country, with general practitioners leading the way, although specialists have started to follow.

Read the full article at the Courier Times

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Disney Plus — for Health Care?

Over 10 million people have signed up for Disney Plus since it launched last year. It’s easy to understand why. The service gives subscribers access to hundreds of movies and television shows for just $7 a month — no cable plan required.

Imagine if we applied that model to health care. For a flat monthly fee, subscribers could get everything from flu shots to lab tests “on demand” — no expensive, cumbersome insurance plan required.

This model already exists. It’s called direct primary care — and Americans young and old, rich and poor alike are increasingly turning to it as a means of securing affordable, high-quality health care.

Under direct primary care, a patient pays a doctor a subscription-style fee in exchange for access to an array of services. Just a decade ago, there were only a handful of direct primary care practices scattered across the country. Today, over 1,000 serve around half a million people in 49 states.

Read the full article at The Desert Review

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The Direct Primary Care Solution for America’s Health Care Woes

Austin — “the live music capital of the world” — is a lovably “weird” city and home to many musicians and artists. Willie Nelson, Stevie Ray Vaughan, Townes Van Zandt, and Janis Joplin all called it home at one time or another. Great venues like Antone’s, the Broken Spoke, and Stubb’s kept the music scene alive for years, and as it continues to evolve, they serve as storied reminders of what has always made Austin great — a vibrant arts scene.

When I was in law school at the University of Texas, I remember rushing to buy the 2-CD KHYI set each year for the best music of the day. But I also recall that the proceeds from the sale of the set went to providing health insurance for artists. This was a way people in the arts community looked after one another.

Unfortunately, while the creative community remains alive in Austin, the rising cost of housing, driven both by demand and by property taxes, and the skyrocketing cost of health care are crushing many of the artists who live gig to gig and paycheck to paycheck. Since 2013, insurance premiums have gone up more than 60 percent across the board, while private-market premiums have doubled and even tripled. While Washington “leaders” dither and waste time, some creative doctors are using a fast-growing direct-primary-care (DPC) model that may well save the day.

Read the full article at National Review

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Policy Tip Sheet: States Should Expand Direct Primary Care to Help Expand Availability of Primary Care

One of the lesser-known factors driving skyrocketing health care costs throughout the country is the lack of primary care physicians. Indeed, many states are experiencing a severe shortage of primary care physicians. According to a 2018 report from United Health Group, 13 percent of American patients live in a county with a shortage of primary care physicians.

This shortage is exacerbated by the fact that many new physicians choose to practice specialty medicine instead of primary care. Although there are many reasons for this shift, the high costs and logistical challenges inherent in primary care medicine are major contributing factors. According to the American Journal of Medicine, the percentage of American primary care physicians decreased from 50 percent in 1961 to 33 percent in 2015. The United Health study also found that only 288,000 out of 869,000 physicians conduct primary care services.

Unfortunately, this problem is likely to become worse before it becomes better. The United Health Group study estimates that by 2030 there will only be 306,000 primary care providers in the nation. Additionally, by 2032, the number of Americans over the age of 65 will increase by 48 percent, according to the U.S. Census Bureau. This, along with several other factors, will magnify the need for primary care doctors.

Read The Full Article at Heartland Institute

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The Advantage of Paying for Medical Care Directly

According to a PBS health report about a retiree on a Medicare Advantage plan, Z. Ming Ma was issued a prescription from her physician that cost $285 for a 90-day supply. “A month later,” the article says, “Ma and his wife were about to leave on another trip, and Ma needed to stock up on her medication.”

But her 90 days weren’t up, so Anthem wouldn’t cover it. “Ma asked the pharmacist how much it would cost if she got the prescription there and paid out of pocket,” the article says.

The total cash price was about $40.

This is not uncommon. In fact, a study from USC demonstrated that nearly 25 percent of all prescriptions filled at the pharmacy cost the insurer less than what the patient paid in a copay. Yes, that means paying cash is more affordable than using your insurance card.

 

Read the Full Article at The Hill

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More Patients Turning to ‘Direct Primary Care’

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.

“It’s awesome that I can call or text Dr. Josh Umbehr when my children are sick and that I have a solution before they leave for school,” he says.

For example, when one child woke up coughing recently, Mick and his wife, Jennifer, contacted ‘Dr. Josh,’ who asked them to put her on the phone to hear her cough and then take a picture of her throat and text it to him.

“He prescribed an antibiotic, which we picked up at his office the same day.”

 

Read the Full Article at WebMD

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