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Direct Primary Care Legislation Passes Congress

Direct Primary Care Legislation Passes Congress
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Updated October 31, 2018

Thank you Congressman Tom Cole

The U.S. House of Representatives passed HR 6199 the Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018 on July 25 by a vote of 277-142. View votes

Our Congressman Tom Cole joined a bipartisan majority to fix an IRS problem that has prevented Oklahomans from using their health savings accounts (HSAs) to pay membership dues at MainSt. Clinic and other direct primary care (DPC) clinics across Oklahoma and the U.S.

The IRS has ruled that direct primary care (DPC) clinic membership is a “separate health plan.” Under this IRS rule, taxpayers are prevented from spending their own HSA money on membership at MainStreet Clinic or any DPC clinic – or even belonging to a DPC clinic if they are currently contributing to an HSA. Congressional action is required to fix this and overrule the IRS.

Thanks also to our Washington lobbyist Jay Keese at Capitol Advocates for his hard work over the past five years to make this happen. But we’re not finished!

Next Step: On To The Senate

What can you do?

1. Call or write Congressman Tom Cole to thank him for his leadership on this matter. Tom Cole just happens to be the Chairman of the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies. Mr. Cole’s subcommittee has a voice in shaping health care policy and he is an important leader in Congress. Ask Mr. Cole to use his leverage to pass future legislation to permanently fix this problem (see #3 below). 

2. Contact Senators Jim Inhofe and James Lankford to request they do the same: support the Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018 in the Senate and co-sponsor the Primary Care Enhancement Act, SB 1358, with Sen. Bill Cassidy (R-LA).

3. Ask Rep. Cole and Sens. Inhofe and Lankford to support future legislation to permanently fix this problem by making direct primary care (DPC) clinic membership fees normal, qualified medical expenses under Section 213(d) of the U.S. Tax Code, like other doctor’s fees already are!

Yes, this sounds confusing because it is.

What this means is that when the cost of belonging to MainSt. Clinic is considered a “qualified medical expense” by the IRS, and no longer a “separate health plan,” then your membership fees will be tax-deductible and all the problems of paying for membership with health reimbursement accounts (HRAs) or flex spending accounts (FSAs) will be eliminated!

Contact Congress:

Rep. Tom Cole

Email
2467 Rayburn HOB
Washington, DC 20515
Phone: (202) 225-6165

Sen. Jim Inhofe

Email

205 Russell Senate Office Building
Washington, DC 20510
Phone: (202) 224-4721

Sen. James Lankford

Email

316 Hart Senate Office Building
Washington, D.C. 20510
Phone: (202) 224-5754

Posted in: Community Health Policy, Direct Primary Care, News

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Many People Feel That Without Coverage, They Can’t Get Care

Many People Feel That Without Coverage, They Can’t Get Care

As seen in the Lawton Constitution December 21, 2017

Priced out of health insurance? Or do you feel it is too expensive to use?

We enjoy quality medical facilities and excellent health care providers in Lawton. But these services do not help people who cannot afford to access them.

Many working people feel they have been priced out of health insurance. And since health CARE has been inseparably linked to health insurance COVERAGE, many feel that without coverage, they can’t get care. While many who do have coverage feel that the cost of getting care makes their health insurance too expensive to use.
“The cost of health care in 2016 exceeded $25,000 per family,” according to the Milliman Index. And worse, cost per family has doubled from $12,500 in 2005, when Milliman first began tracking it.*

Direct primary care clinic membership offers personalized care, no insurance required

Direct primary care clinic membership is “centered around you,” old-fashioned health care from a personal physician. An old idea made new again. And clinic membership is also an ideal source of care for people who have no health insurance or who feel their coverage is too expensive to use for primary care.

Membership allows for unhurried visits where your Doctor has more time to hear your concerns, understand your health problems and provide you with the care and treatment you need.

Nationwide, face-time with a primary care Doctor averages seven to 10 minutes per visit. In direct primary care, Doctor face-time averages 35 minutes or more.** Ample time with your primary care Doctor is the foundation of effective health care. Time together builds trust. From trusting relationships, coupled with your Doctor’s expertise and experience, come the best decisions for your health.

“This is not football with the clock tick, tick, ticking down … Direct primary care clinic membership is like baseball. You have the time you need.” — Dr. Birdwell

The flat monthly membership fee includes:

  • Annual comprehensive wellness and medical exam
  • Unlimited clinic visits with same day/next day appointments
  • Discounts on labs, imaging and medications provide major savings
  • 24/7 communications via cell, text and email
  • Wellness counseling
  • Referrals to medical specialists and hospital-to-home coordination
  • Coordination of care to maximize the value of any insurance our members have
  • House call option
  • No long-term commitment

Ask about it at work!

Direct primary care clinic membership is a “care first” employer-sponsored group health benefit:

  • A flat monthly fee for all primary health care can be budgeted easily
  • Quality health care that can be accessed quickly and after hours is the ideal health benefit for business owner and employee alike
  • Many occupational health services are included in clinic membership
  • Vision care, too

MainStreet Direct Care proves to be the ideal (or only) source of care for many SW Oklahomans. With or without coverage, we help maximize the value of any insurance our members have and seek less-expensive alternatives where possible. Dispensing many prescription medicines at very low cost helps many families make ends meet.

When extra tests or specialized care is needed, we take time to help members make decisions and find strategies for affordability.

Direct Primary Care is the future of health care, available today. It’s about care, not coverage

* Source: Milliman Index (www.milliman.com/mmi). Total cost includes coverage premiums plus the costs of care for a typical family of four, covered by an average employer-sponsored PPO plan.

** North Carolina State University MBA project comparing North Carolina direct pay medical practices to data collected from traditional practices

Posted in: Direct Primary Care, Workplace Health

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The Open Health Care Economy

Priced Out of Health Insurance and Care

Brian Birdwell, MDBy Brian Birdwell, M.D.

Published in the Lawton Constitution
February 16, 2017

We enjoy quality medical facilities and excellent professional health care providers in Lawton. But these services do not help people who cannot afford to access them.

Many working people in Lawton and Southwest Oklahoma feel they have been priced out of health insurance. 

“The cost of health care in 2016 exceeded $25,000 per family.”

Health insurance coverage is expensive, both on the front end (premiums) and also on the back end (co-pays, deductibles, and co-insurance). The total cost of health care in 2016 exceeded $25,000 per family. Let that sink in, while I add that this cost per family has doubled from $12,500 in 2005, when the Milliman Index first began tracking it.*

Closed System

Prices are not open for consumers to see. The U.S. health care economy is a closed system. Actual price agreements for surgery, hospitalization, pharmacy and so forth are negotiated behind closed doors and we physicians have very little to say about what charges are permitted and what you must pay.

These are actual prices and discounts for an MRI from one of my patients with typical major medical coverage in a high-deductible plan:

Billed amount    $4,873
PPO discount    – $4,144
Actual price paid    $729

So, even with insurance, the typical “discounted” price was more than $700. And if you don’t have these “discounts,” you get a double-whammy: You’d have to pay the entire, inflated price of $4,873.

Insurance and our closed system drives up the cost for insured and uninsured alike.

By comparison, cash-paying members are referred for a comparable MRI in the open health care economy for about $350, sometimes less. These cash prices work for patients with, or without, a major medical insurance plan.

Taking Down The Barriers To An Open Health Care Economy

MainStreet Clinic is a point of entry for our members to access an open health care economy:

  • Direct primary care membership prices are viewable on our website
  • Membership is affordable: $40 to $80 per month, similar to a typical cell phone bill
  • We provide access to discounts for otherwise expensive services, such as MRIs, CAT scans and lab tests
  • We can fill prescriptions for many generic medications at low discounted prices
  • Access to MainStreet Clinic is unlimited for members; you see your doctor whenever the need arises
  • Members experience unhurried visits – time to explain, ask questions, be heard
  • Ongoing 24/7 contact via personal communications, such as cell phone, text or email – because sometimes, all that’s needed is a little information or an answer to a question

Employee Benefits That People Want and Can Afford

MainStreet Clinic membership is an ideal employer-sponsored health benefit. Clinic membership is a care-first health benefit that people can use with no insurance coverage required.

“For as little as $20 to $30 per employee per month, employers can ensure access to care for their people.”

For employers:

  • A flat monthly fee for all primary health care can be budgeted, easily
  • The membership benefit may be defined as all employer-paid or partially employee-paid
  • Employees access care quickly during office hours and after-hours, either in person or via cell phone, text or email
  • The clinic membership agreement is entered into by each employee individually; we protect the doctor-patient relationship

Vision care, too. When employers offer access to MainStreet Clinic membership, workers who subscribe may also enroll in Primary Vision Care Services.

Taking down barriers and opening the door to a new health care economy is a joint effort by all market players: health care providers, consumers and employers. Lawton’s own Keith Smith, M.D. at the Surgery Center of Oklahoma has attracted national attention for their totally transparent pricing.

Our hope is that others will follow the MainStreet Clinic lead in Lawton. The benefit to the health of Southwest Oklahoma’s people and businesses will be positive and far-reaching.

* Source: Milliman Index (www.milliman.com/mmi). Total cost includes coverage premiums plus the costs of care for a typical family of four, covered by an average employer-sponsored PPO plan.

Posted in: Direct Primary Care

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Seeking a Renaissance in Personalized Health Care

Dr. Brian Birdwell, MD - Lawton, Oklahoma

Young people in Lawton tell us that direct primary care clinic membership is a “progressive innovation!” And then our senior members say, “That’s no innovation. It’s the way health care used to be!”

Both young and old agree: direct primary care clinic membership delivers personalized health care the way it should be now:

  • See your doctor promptly, in a calm clinic with uncrowded waiting room
  • Unhurried visits with a doctor who has plenty of time to listen, and who can take into consideration your goals for your health and well-being
  • Ongoing contact via personal communications, such as cell phone, text or email

Clinic members pay a flat monthly fee and in return, receive open access and attention to any pressing need. When a face-to-face visit is desired, doctor appointments can be made, typically the same day or next day. Time with your doctor is not limited by a ticking clock.

And on occasion, we even make house calls.

How is this possible?

Since we no longer must see you face-to-face in order to get paid by Medicare or the health insurance company, patient-doctor communication is not bound by the structure of electronic records or the duty to produce a bill. By contrast, in preferred provider networks (PPOs), the main focus of a primary care “patient encounter” has become generating a bill rather than promoting your health and well-being.

Nationwide, face-time with a primary care doctor averages seven to 10 minutes. In direct primary care, doctor face-time averages 35 to 45 minutes. Ample time with your primary care doctor is the foundation of effective health care. Time together builds trust. From trusting relationships, coupled with your doctor’s expertise and experience, come the best decisions for your health.

“This is not football with a ticking clock. Direct primary care clinic membership is like baseball. You have all the time you need.”

———

Remedy for employers agonizing over group health benefits

Two reasons why direct primary care clinic membership is ideal for employer group health plans:

  • A flat monthly fee for all primary health care can be budgeted easily, and
  • Quality health care that can be accessed quickly is the ideal health benefit for business owner and employee alike

Moreover, as Forbes.com columnist Dave Chase pointed out recently, “the typical American family with a Boomer head of household has $1 million less in their retirement account than they would have if healthcare spending had tracked with inflation, rather than healthcare’s hyperinflation.”

Shifting employee benefit dollars from health insurance back to direct health care spending has been proven to reduce employer health costs by 20 percent, which over time can loosen more benefits dollars for financial protection benefits and retirement savings.

Direct Care Partners, LLC offers employers Care First Benefits. Care First includes a simple way to contract directly with Lawton area physicians to provide these benefits in your group health plan, along with expert consulting to help you balance your plan’s health care, catastrophic health insurance, and financial protection benefits.

Posted in: Direct Primary Care

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Personalized Health Care The Way It Should Be

KCCU Community Focus

Public Radio Interview With Dr. Brian Birdwell

“Have you ever heard of Direct Primary Care ? It’s a little different from what most of us are used to when we visit the doctor. It’s actually based on care and not coverage. It’s a revolution in Primary Care. Dr. Brian Birdwell joins me in studio for an interview all about the topic of health care the way it should be.

 Personalized Health Care The Way It Should Be

Breanne Loving and Dr. Brian Birdwell of MainStreet Clinic on KCCU’s Community Focus.
CREDIT KCCU AND CAMERON FILES. PHOTO BY : MOISES RIVERA

Listen to Breanne Loving discuss health care the way it should be with Dr. Brian Birdwell on KCCU Public Radio Community Focus.

Health Care The Way It Should Be

Direct primary care clinic membership enables physicians to provide highly personalized health care the way it should be. Many young people say to Dr. Birdwell, “this is a progressive innovation!” While clinic members who are senior citizens say, “That’s no innovation. It’s the way health care used to be!”

“This is not football with a ticking clock. Direct primary care clinic membership is like baseball. You have all the time you need.” — Dr. Brian Birdwell of MainStreet Clinic

As the concept of direct primary care membership grows in awareness, many agree that it delivers personalized health care the way it should be now. The doctor is available promptly, typically same day or next day. Doctor visits are unhurried with plenty of time for the doctor to listen, and take into consideration each member’s own health care goals.

Since face-to-face doctor visits are not required for insurance reimbursement, doctor and member can have ongoing contact via personal communications, such as cell phone, text or email. Clinic members pay a flat monthly fee and in return, receive open access and attention to any pressing need. And on occasion, direct primary care doctors even make house calls.

Read more about personalized health care

About Brian Birdwell, MD and MainStreet Clinic

Lawton internist Brian Birdwell, M.D. is owner and physician-director of the MainStreet Clinic team of medical professionals. MainStreet Clinic is a direct primary care membership clinic offering innovative medical services in the old fashioned style of a personal physician caring for each patient individually, “health care the way it should be.” MainStreet Clinic Services include complete primary care services for individuals and families, regardless of insurance coverage, and occupational health and wellness services for employers.

Posted in: Direct Primary Care, Health Blog

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Care First Alliance To Help Lawton Business Adopt Direct Primary Care

Care First provides Lawton business with creative alternatives in health benefits featuring direct primary care membership

Care First Alliance Direct Primary Care

LAWTON — Dr. Brian Birdwell announced the introduction of Care First Benefits to  provide Lawton area employers with creative alternatives featuring direct primary care membership benefits for employees.

“Health care has been turned upside down by radical changes and spiraling insurance costs, and business owners need fresh alternatives that provide affordable care their people can actually access and use,” said Craig Scurato of Simplifi Benefits.

“Direct primary care membership is relationship-based medicine, where patients have all the time they need, as often as they need it, and same day or next day clinic access for one, flat monthly membership fee averaging about $60 per employee, per month,” said Dr. Brian Birdwell.

Lawton area business owners are invited to a Care First Employer Briefing Tuesday afternoon, March 8, come and go between 4:00 and 7:00 pm at the Chianti Wine Bar, 5370 NW Cache Road, presented by MainStreet Clinic, Direct Care Partners and Simplifi Benefits. Please R.S.V.P. at (580) 248-9966.

About Brian Birdwell, MD and MainStreet Clinic

Lawton internist Brian Birdwell, M.D. is owner and physician-director of the MainStreet Clinic team of medical professionals. MainStreet Clinic is a direct primary care membership clinic offering innovative medical services in the old fashioned style of a personal physician caring for each patient individually. Clinic services include complete primary care services for individuals and families, regardless of insurance coverage, and occupational health and wellness services for employers

About Direct Care Partners, LLC

Dr. Brian Birdwell co-founded Direct Care Partners, LLC with Rob Bartlett, Jr. in order to accelerate and scale the growth of direct primary care in the Greater Lawton Area and across Oklahoma.

About Craig Scurato

Craig Scurato, president of Simplifi Benefits (www.simplifibenefits.com), provides consulting assistance to direct primary care physicians, and offers small and mid-size employers with a competitive advantage in the health insurance marketplace, through its own private marketplace exchange and access to a wide range of insurance and benefits products.

Posted in: Direct Primary Care, Health Blog, News

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Quality Health Care Is About Time, And The Time Is Now

By Jeff Davenport, MD (Edmond) and Brian Birdwell, MD (Lawton)

First published in the Lawton Constitution

Grand schemes by government and large corporations to reform health care in the U.S. always have good intentions and yet they all share one failure: they overlook the front lines of health care, which is the primary care physician’s office.

Primary care doctors have been put in a vise by the efforts of insurance companies and Medicare to manage health care costs through price controls and imposed regulation. The paperwork burden on physicians for coding, filing insurance claims, submitting documentation and phone calls to payers adds $50 on top of the real cost for every patient encounter. Adding insult to injury, both public and private payers restrict the compensation physicians can receive for providing patient health care, which inevitably cuts down the time we may spend with our patients. To make financial ends meet, the typical primary care physician has less than 15 minutes of actual face-time with each patient.

This might be an acceptable burden if it led to quality care and patient satisfaction. But sadly, quality and satisfaction are the worst casualties of public and private sector attempts at managed care.

The most valuable component of primary medical care is TIME: time with patients; time to listen and to let patients know they are being heard; time to learn about everything that impacts our patients’ health; time to coordinate all the factors and render the highest quality of care, based on our medical training and professional judgment; time to actually care. Because “it’s about care, not coverage.” *

Entering into primary care has become an unappetizing career path for residents emerging from medical school. And this at a time when public health experts are pointing to a potential crisis in insufficient numbers of primary care doctors.

But there is hope.

A new medical and business model for the primary care doctor’s office is catching on. We call it “direct primary care,” because it is based on a simple idea: the patient joins the doctor’s clinic as a member, pays the doctor directly, and now, the doctor works only for the patient.

For around the cost of a monthly cable or cell phone bill, most consumers can be assured of access to their doctor, when they need it, and comprehensive primary medical care throughout the year, including preventive care.

We have established this direct primary care model in our clinics and hear from many other Oklahoma physicians who want to do the same in their health care practice. We agree that health insurance is an important protection, and with this model, insurance can be reserved for its true purpose: unplanned or prohibitively expensive procedures for an individual or their family.

As primary care doctors, we are not alone. Innovative employers are stepping up to offer their employees reimbursement for direct primary care membership fees. And now, thanks to the leadership of Senators Rob Standridge of Norman and Ervin Yen of Oklahoma City, the Oklahoma Senate Insurance Committee has passed Senate Bill (SB) 560 to protect patients’ and physicians’ rights to enter into direct primary care membership agreements without the interference of insurance regulations.

Voters, please contact your representatives in the legislature and thank them for supporting SB 560 in the Senate and the House. And physicians, please take a close look at direct primary care and ask if this health care model is right for you and your patients. It’s about time.

Jeff Davenport, MD is a family physician and owner of One Focus Medical in Edmond. Brian Birdwell, MD is an internist and occupational medicine physician, owner of MainSt. Clinic in Lawton. 

* “It’s about care, not coverage.” is a registered trademark in the U.S. by Direct Care Partners, LLC in Lawton, Oklahoma.

Posted in: Community Health Policy, Direct Primary Care

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Direct Primary Care, A Simple Solution

The current health care system has become unsustainable, with costs for health insurance spiraling upward year over year at a rate several times greater than inflation. And while costs have risen sharply, the system has also failed to deliver affordable primary care to a large slice of the U.S. public, 50,000,000 by some counts.

After 25 years of experiments with insurance managed care, the result is

  • ineffective cost management,
  • decreased quality and availability of primary care for many people, and
  • loss of professional satisfaction among physicians.

The direct primary care solution is simple: De-couple care from coverage and offer health care consumers a low monthly clinic membership. Imagine primary care like this:

  • patients subscribe directly to the clinic of their choice,
  • pay modest monthly membership dues, and
  • receive the primary care they need, when they need it, on their terms.

Direct primary care membership ensures same day or next day appointments, along with longer, unhurried clinic visits. By eliminating insurance reimbursement, coding, billing and collections, as much as $50 per patient encounter is also eliminated. Costs are lowered. And the physician now works only for the patient.

Direct primary care membership is based on a simple, entrepreneurial business model, that supports a better medical model of primary care.

Posted in: Direct Primary Care, Health Blog

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