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  • Direct primary care: A light in the darkness

    Tags: DPC, direct primary care

    By Kissi Blackwell, MD

    Recent events have shed light on the existing difficulties facing family physicians and have revealed the fragility of the current healthcare system. The SARS-CoV-2 pandemic has devastated our health care delivery process, and many family physicians are facing the difficult decision to close their doors or contend with salary reductions due to sharply decreased face-to-face visits. Now, more than ever, patients are valuing visits that can take place outside of the exam room, and, unfortunately, reimbursement has been severely lacking for virtual visits for traditional fee-for-service practices.

    In the midst of all this uncertainty, there has been an inherent need to shift the way we approach primary care delivery and payment. In a time where we stand to lose thousands of primary care physicians to financial difficulties or retirement forced upon them by the current situation, we owe it to our profession to find a better way.

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  • Direct primary care: A light in the darkness

    By Kissi Blackwell, MD

    Recent events have shed light on the existing difficulties facing family physicians and have revealed the fragility of the current healthcare system. The SARS-CoV-2 pandemic has devastated our health care delivery process, and many family physicians are facing the difficult decision to close their doors or contend with salary reductions due to sharply decreased face-to-face visits. Now, more than ever, patients are valuing visits that can take place outside of the exam room, and, unfortunately, reimbursement has been severely lacking for virtual visits for traditional fee-for-service practices.

    In the midst of all this uncertainty, there has been an inherent need to shift the way we approach primary care delivery and payment. In a time where we stand to lose thousands of primary care physicians to financial difficulties or retirement forced upon them by the current situation, we owe it to our profession to find a better way.

    more
  • Interested in direct primary care? Ask your U.S. representative to sign on to the Primary Care Enhancement Act

    Tags: AAFP's Speak Out, Direct Primary Care Coalition, aafp, direct primary care, DPC

    By Jonathan Nelson

    Direct primary care practices are cropping up across the country as physicians grow more frustrated by administrative burdens inherent in a fee-for-service third-party insurance market. But some regulatory obstacles block many people from joining DPC practices. The Direct Primary Care Coalition — of which TAFP is a steering committee member — has called on physicians to ask their representatives in Washington D.C. to sign on to federal legislation that would remove those obstacles.

    In DPC practices, physicians charge patients a monthly, quarterly, or annual fee — like a retainer or membership fee — that covers a broad set of primary care services and patients typically enjoy greatly enhanced access to their physician. IRS rules interpret these DPC payments to be like paying premiums for health insurance rather than just a different way to purchase a set of services. Even though Texas and 17 other states have passed laws defining DPC arrangements to be outside of state insurance regulation, the IRS interpretation bars individuals with health savings accounts paired with high-deductible health plans from using their HSA funds to pay DPC fees.

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  • The 24-hour primary care clinic

    Tags: 24 hour care model, Corpus christi Medical associates, J. Stefan Walker, 24 hour primary care clinic

    A model whose time has come

    J. Stefan Walker, MD

    Luke Fildes’ portrait “the doctor” epitomizes the primary care physician that our younger selves aspired to become.That kind of doctor-owned practice is now slipping away as quickly as the business model supporting it. Where $300,000 per year is the new benchmark for employed primary care positions, the prospect of starting or joining a private practice only to tread water in a sea of acronyms (MACRA, HIPAA, HMO, ACO, etc.) for margins that barely cover overhead no longer makes sense to most family physicians. No wonder that in 2016, for the first time, less than half of American doctors partly or fully own their practices.

    As the care of inpatients became a separate field, primary care was mostly sidelined into a 9 to 5 office job in a role now shared with mid-level practitioners, retail clinics, and telemedicine services. Unlike many other specialists still seeing patients during nights and weekends, primary care is now conspicuously absent in that important space, further putting pressure on family physicians to justify the level of reimbursement that can support independent practices. Now a rarity, small primary care practices — even those now thriving — risk succumbing to this tide of obsolescence, not unlike local department stores and indoor shopping malls.

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  • Primary Care in Texas: Condition Critical

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    Texas’ primary care workforce shortage threatens the health of the state’s economy and its citizens. The 83rd Texas Legislature can lay the foundation for innovation and improvement … more