by Jordan Roberts
Director of Government Affairs, John Locke Foundation
I have a “Google alert” set up for “direct primary care” (DPC) to read all of the articles written on this topic from around the country. Many of these articles describe primary care physicians who are burnt out from the daily battle between providing patients care and dealing with insurance and bureaucratic paperwork. Sometimes they make the choice to switch to a DPC model. Consider this article about Dr. Jeff O’Boyle from Ann Arbor Michigan:
“We don’t want those people here.”
That was the response Dr. Jeff O’Boyle got from a human resources director when he asked about helping patients with addictions through recovery. It was also how O’Boyle knew it was time to quit the large regional health care system he was working at.
So last year O’Boyle opened Beyond Primary Care, located at 2500 Packard St., Suite 105 in Ann Arbor. His practice is one of only a handful in the U.S. to offer “direct primary care,” where patients pay their caregivers directly without insurance company involvement.
Adult patients pay O’Boyle between $30 and $90 per month, following a tiered pricing model that increases with the patient’s age, for unlimited visits. Children 18 and under are $15 per month when at least one parent is also enrolled.
Other items such as bloodwork and prescriptions can add up for patients, but O’Boyle’s practice makes that more manageable as well by offering in-house labs and prescriptions at cost. O’Boyle says his mission is to “create time and space for my patients without unnecessary overhead from insurance.”
The model also allows him to provide personalized care in a way that isn’t often available through large health care systems. O’Boyle notes that several minutes of a traditional 15-minute doctor’s appointment are spent on greetings, doing intake, and taking vitals.
Direct primary care is a model for providing primary care where there is no insurance accepted. For a monthly fee, patients have unlimited access to their primary care doctors. Monthly prices vary, but as is the case with Dr. O’Boyle, the price for an individual is between $30-$90 a month – sometimes the co-pay of just a few visits to primary care with traditional insurance. DPC doctors have substantially more freedom from onerous regulations because the monthly payment in most states is not considered an insurance premium, therefore not subject to insurance regulations.
Recently on the blog, I discussed an op-ed written by David Balat of the Texas Public Policy Foundation and his experience with DPC. Patients around the country could heavily utilize this healthcare model because of its affordability. Congress could make this model even more accessible by changing the laws regulating health savings accounts:
Federal law hinders the flexibility for families to access these alternative health arrangements by limiting the use of health savings accounts (HSA). David explains his current experience using direct primary care and what Congress can do to increase the use of these affordable plans:
How does it work? I’m an example. I have a high-deductible health plan, but I also utilize a membership with my direct primary care physician in my area for my family’s primary care needs. I have a relationship with my doctor that I value for the very real health benefits it incurs — the kind of relationship President Obama promised all of us when he (falsely) said, “if you like your doctor, you can keep your doctor.”
I also have an HSA funded by my employer, and I’d like to use those dollars to pay my membership. The IRS, however, does not recognize my relationship with the doctor as a qualified medical expense but rather as a second plan.
Congress can fix this. To do so, it would have to instruct the IRS that direct primary care is not a second health care plan. Under ACA rules, only individuals with a HDHP are eligible to have an HSA; the presence of a second plan (in this case membership in a direct primary care system) would invalidate a family’s eligibility.
The case of Dr. Jeff O’Boyle offers two valuable lessons. First, there are more affordable models to access care than having traditional insurance with a government-mandated set of benefits. Second, because of excessive insurance regulations and other bureaucratic barriers, many doctors become frustrated with their lack of time to do their actual job: care for patients.