Direct Primary Care Town Hall Meeting. Harmony Family Medicine

Transcription

1 Direct Primary Care Town Hall Meeting Harmony Family Medicine

2 Why are we changing? Dr. Neely s basic philosophy of spending time with patients does not lend to running a profitable business under current healthcare environment. She needed to see too many patients a day and needed a large patient panel to support that. All of this has had an impact on patient satisfaction and outcomes Unable to see doctor when needed Increased wait times in waiting room Slower response to questions and lab work review

3 When does this change happen? January 1, 2017 We will remain on all insurance plans through December We have to give days notice to insurance companies. These notices have been sent.

4 Principals of DPC Service: The hallmark of DPC is adequate time spent between patient and physician, creating an enduring doctor-patient relationship. Supported by unfettered access to care, DPC enables unhurried interactions and frequent discussions to assess lifestyle choices and treatment decisions aimed at long term health and wellbeing. DPC practices have extended hours, ready access to urgent care, and patient panel sizes small enough to support this commitment to service. Patient Choice: Patients in DPC choose their own personal physician and are reactive partners in their healthcare. Empowered by accurate information at the point of care, patients are fully involved in making their own medical and financial choices. DPC patients have the right to transparent pricing, access, and availability of all services provided.

5 Principals of DPC (continued) Elimination of Fee-For-Service: DPC eliminates undesired fee-forservice(ffs) incentives in primary care. These incentives distort healthcare decision-making by rewarding volume over value. This undermines the trust that supports the patient-provider relationship and rewards expensive and inappropriate testing, referral, and treatment. DPC replaces FFS with a simple flat monthly fee that covers comprehensive primary care services. Fees must be adequate to allow for appropriately sized patient panels to support this level of care so that DPC providers can resist the numerous other financial incentives that distort care decisions and endanger the doctorpatient relationship.

6 Principals of DPC (continued) Advocacy: DPC providers are committed advocates for patients within the healthcare system. They have time to make informed, appropriate referrals and support patient needs when they are outside of primary care. DPC providers accept the responsibility to be available to patients serving as patient guides. No matter where patients are in the system, physicians provide them with information about the quality, cost, and patient experience of care. Stewardship: DPC providers believe that healthcare must provide more value to the patient and the system. Healthcare can, and must, be higherperforming, more patient-responsive, less invasive, and less expensive than it is today. The ultimate goal is health and wellbeing, not simply the treatment of disease.

7 Direct Primary Care Provides Excellent care for all, regardless of insurance. Insurance inherently creates a class system in healthcare. Some insurers reimburse providers more than others. DPC insures there is no class order. Better access to doctor and staff Phone Text Our attention because we are not dealing with insurance and claims issues. And we are not having to see patients a day. Time that we can coordinate the care you get from us, specialists, and at the hospital.

8 Differences from Concierge Medicine Low monthly fee (Concierge requires expensive quarterly or annual retainers) Do not bill insurance (Concierge bills insurance too!) DPC includes more services in the membership fee than Concierge DPC has shown improved outcomes, increased service level and reduced overall health costs. Ted Metz ran for Georgia insurance commissioner in He described DPC as concierge medicine for the little guy and ran on a platform to get widespread adoption of DPC in Georgia.

9 DPC has proven to be a win for all Currently about 450 known practices using the DPC model across the US. American Academy of Family Physicians (AAFP) supports DPC as an alternative payment model to traditional fee for service. 3% of AAFP members practice in a DPC setting. Dr. Neely is a member of the AAFP. Many offices are transitioning to DPC every year. There are several DPC clinics already established across Georgia. It has proven to improve outcomes and service while reducing overall healthcare costs.

10 Membership Fees Many practices charge a sliding scale based on age with the upper fee range a little over $100 for older patients. We decided to have a flat fee for adult members of $69 regardless of age. Dependents will be $20 if they sign up with an adult member. In addition, there is a $60 enrollment fee. Enrollment fee is waived if you sign up before January 1 st.

11 Paying the Membership Fee We prefer you pay monthly using automatic debits from a credit card or checking account. If you want to pay in advance, we will offer a 10% discount for those that do prepay for the first year. We expect that the discount will go down to 5% in 2018 or be completely eliminated. We are using the pre-pay as an incentive for the first year. We will have software in place for you to manage the payment method.

12 Signup/Cancel/Signup Can t I just pay for a month, cancel and then join back up in 3 months when I need something? If you cancel: You will go to the back of the waiting list. We cannot guarantee we will have room for you when you decide to rejoin. In addition, you will need to pay the enrollment fee again. If anything comes up during that inactive period, you will have to see an urgent care or other provider. Refills will not be handled, etc. DPC practices see less attrition than traditional practices due to the quality of care.

13 What services are provided in the Membership Fee? Reference our brochure for full list. Office visits (wellness, acute care, disease management and sports physicals) Ability to communicate with physician and staff via secure online messaging Access to physician and staff via phone/text (including after -hours) Coordination of care with specialists, hospitals and other care providers Annual physical with lab work and comprehensive care plan Common Injections (B-12, steroid) Common procedures (skin, orthopedic, ear washes, etc) 10% off all supplements/vitamins that we stock

14 What is not provided in Fee? Outside labs beyond a single panel during your annual physical If you want to use your insurance for labs you may need to go to a lab service center to have them drawn. Vaccines* and Flu shots* Any Durable Medical Equipment Prescription Medicine

15 Future Services X-Ray Hopefully in a 1-3 year time frame.

16 How does this impact or work with my current insurance? Medicare There are three Medicare contractual options for Providers: Participating provider (what we are today) Non-participating provider who accepts assignment (provider is paid by Medicare for claim) Non-participating provider who DOES NOT accept assignment (you pay provider and Medicare pays you for claim) Or a provider can opt out of Medicare completely and enter into private contracts with Medicare patients. We are opting out of Medicare so we don t run afoul of Medicare regulations in regards to the membership fee.

17 How does this impact or work with my current insurance? Medicare This means we will enter into a private contract between the patient and Dr. Neely. This will be defined in our membership agreement and it will state that: We cannot bill Medicare for any service we provide to patients. We cannot facilitate you getting reimbursed by Medicare for any services we provide. You as the patient cannot get reimbursed by Medicare for any services we provide. We can still send orders to Home Health Agencies, Imaging Providers, specialists, DME, pharmacies, etc. And you can use your insurance with them if they take Medicare. Prescriptions: You can use Part D or purchase your meds from us. We will help you to determine which way is cheaper. Reference: MLN/MLNMattersArticles/downloads/SE1311.pdf

18 How does this impact or work with my current insurance? High Deductible PPO/POS You will probably save money over using your insurance. You will no longer have to pay the full charges for visits since they are included in your membership fee. You will no longer have to pay high retail rates for labs that went to your deductible. Instead of $500 it would be less than $100. Many insurance plans now include prescriptions in the deductible. If you purchase medicines from us at wholesale cost you may save money.

19 How does this impact or work with my current insurance? Traditional low deductible PPO/POS plans No copays You can still use your insurance: For labs - we will provide you with an order to have them drawn at a lab service center. For any specialists that you see or may need Pharmacy Radiology Other providers The lab, pharmacy, radiology or other provider will bill your insurance in the usual manner.

20 How does this impact or work with my current insurance? HMOs May not work for you. You might have to be entirely cash based and only use HMO for emergency care. Open Access or Not? Referrals required? You need to determine if your insurance requires referrals or if you can see specialists without a referral from a PCP. Same for prescriptions. Will they pay for rx written by out of network providers?

21 How does this impact or work with my current insurance? Christian Healthcare Cost Sharing Options They shelter you from the ACA individual mandate penalties. Usually they are in-expensive. But cost sharing does not kick in until a certain funding level is met. When combined with a DPC membership this type of plan may work well.

22 How does this impact or work with my current insurance? Wraparound Plans An extremely new type of plan which has a hole in it for Primary Care. This plan is then paired with a qualified DPC membership. Allied National has one for self-funded small business plans. We will continue to monitor this new type of plan and update our website as we get new information. Catastrophic Plans Very high deductible plans You must qualify by being under 30 or get a hardship exemption.

23 How does this impact or work with my current insurance? Health Savings Accounts/Flexible Spending Accounts IRS and the ACA do not agree Current recommendation is: You cannot use HSA/FSA for membership fees You can use for other expenses that you incur at our office labs, medicines, etc. H.R Primary Care Enhancement Act of 2016 Introduced in House on 9/13/2016 Amends IRS code to recognize DPC and allow paying for membership fees with HSA/FSA funds. Call your congressman to support this bill.

24 How will the office be different under the DPC model than it is today? We mentioned earlier that Dr. Neely already spends time with her patients like a DPC doctor. So that will remain the same but you will feel less rushed. Other things you should notice: Less time waiting before your appointment Same day appointments when you are sick Prescriptions dispensed in the office Not having to come in for things that can easily be handled over the phone. /Phone Consults Changes to our phone system Getting a human Integrated software solution One option includes a smartphone app that lets you upload BP and other health data directly from your Fitbit or Withings app to us. Access to Dr. Neely