Cutting out the middle man

Tags: ragle, president's letter, legislature, 84th, direct primary care, bonnen, hancock

By Dale Ragle, MD
TAFP President, 2014-2015

Greetings colleagues. Do you remember a time when you could take care of your patients without any of the hassle and expense associated with billing insurance companies? When you could spend as much time with your patient as needed? When you simply received payment from your patients instead of some third-party payer?

Many physicians practicing today have only heard stories of those days, but a growing number are rediscovering them by stepping off the insurance treadmill and contracting directly with their patients. Direct primary care is an innovative model for delivering and purchasing health care services that gives physicians and their patients an alternative to the third party, fee-for-service system. For a flat monthly fee, patients have unlimited access to their doctor—in person and by phone or e-mail—for a full range of comprehensive primary care services including acute and urgent care, regular checkups, preventive care, chronic disease management, and care coordination.

According to the Direct Primary Care Coalition, traditional primary care practices spend nearly 65 percent of their revenue on overhead. By removing the insurance bureaucracy like billing, coding, claims processing, and appeals, direct primary care practices report significantly reduced operating expenses.

It sounds almost too good to be true, but as you can read about in this issue of Texas Family Physician, some of our colleagues are having success and enjoying their practices in direct primary care. At both the state and national level, your Academy is paying attention to these developments, offering information and resources online, educational presentations at CME conferences, and advocacy support in legislative arenas.

Here in Texas, TAFP worked with Rep. Greg Bonnen and Sen. Kelly Hancock to file legislation that will improve access to direct primary care by recognizing these arrangements, protecting them, and defining them as outside the scope of state insurance regulation. House Bill 1945 was approved by both the House and the Senate and signed into law by Gov. Greg Abbott.

As value-based payment models begin to replace fee-for-service payment in managed care, physicians are faced with tough decisions about how to change their practices to remain viable and continue providing the best care for their patients. Direct primary care offers one solution. It won’t be right for every family doctor, but if you’re interested in learning more, go to

The passage of H.B. 1945 is one of many successes your Academy claimed during the 84th Texas Legislature, and I would like to thank all those members who gave testimony and support in our advocacy efforts. Thank you to those who made donations to the TAFP Political Action Committee as well as to those who signed up to be Key Contacts. Thank you to members who made phone calls and sent letters and e-mails to your representatives and their staffs. The relationships you build and the conversations you have make all the difference. And thank you especially to those of you who served as Physician of the Day.

No Comments

Add a Comment