Prior Authorizations - take the DPC approach! Don't waste your time! Fight back with the advice of Dr. Greg Zydiak. Here is a copy of the form he uses. Here is the legal precedent he relies on - Gary Gibson, MD v Medco Health Solutions of Columbus North Ltd.
New Price Transparency tools! Remember that patients have the right to request that hospitals NOT bill their insurance.
- ClearHealthCosts
- BlinkHealth
Many states have proposed DPC legislation in the current session. Here are the ones that we are following. If we have left any off the list please let us know by placing a comment below! By the end of this legislative session we could have 20 states with DPC laws on the books!
Wyoming has proposed SF0049. The bill is an excellent piece of legislation that should be supported broadly. It can be viewed here and tracked here.
Virginia has proposed SB 685 which can be tracked here and viewed here. Another good example of DPC legislation, though this one has certainly required some defending.
Florida has proposed companion HB 37 and SB 0132. The house bill can be tracked here and viewed here. The senate bill can be tracked here and viewed here. These have our support as well.
Tennessee has proposed excellent legislation in the form of companion HB 2323 and SB 2443 modeled after Oklahoma's. You can track it here.
Alaska has proposed helpful legislation with HB 159 which can be viewed here and tracked here.
Nebraska has LB 817 that has been proposed by Senator Riepe (who was kind enough to attend the DPC Summit last year). It can be tracked here and viewed here.
Georgia has SB 265 to protect DPC practices. (The same language has also been offered as part of a larger bill - SB 291). These links both display and track the legislation.
By Phil Eskew
Medicaid Update - For all the whispers of state Medicaid programs discussing DPC pilots, none have come to fruition yet. Manatt offers an excellent Medicaid Expansion Recap article. Readers will note the absence of any mention of DPC.
Pharmacy Discount Cards - Any veteran DPC physician would tell you that these items typically are not necessary because they do not actually lead to the most affordable prices for medications. At any rate, they are popular in some areas - usually among "traditional" physicians. Those groups had better watch out! If you have not opted out of Medicare, handing out pharmacy discount cards could amount to False Claims Act or Antikickback liability! Check out this article by Robert M. Wolin "Drug Manufacturer Discount Cards: Accept With Caution." Oddly enough, when nonprofits design "charity" programs to reduce certain costs for beneficiaries of government programs the OIG does not view this as a problem.
This quick update from Health Industry Washington Watch includes the following quote: "MACRA established the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to provide recommendations to the Secretary of Health and Human Services on the criteria for physician-focused APMs, and to submit comments regarding whether specific proposals meet the criteria to be established by the Secretary. " So readers might want to follow this group. Hopefully they will view DPC as an APM (Advanced Payment Model).
For those that hope growth in telemedicine will encourage more DPC, check out this case summary from a group that is battling the Texas Medical Board "Antitrust: “Doctor, Doctor, Give Me the News.”