Board of Directors Letter (May 2018)

Dear DPC Alliance Members,

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First, we wanted to thank you for being a member of this young organization. There has been a significant amount of work in laying the foundations for future growth, but we have been working steadfastly behind the scenes. Many of you are already helping in those efforts. Thank you.

This is the first of our Board of Directors letter which is planned to be quarterly-ish. We feel that several topics need to be addressed promptly so this will be a bit longer than future BOD letters.


CREATING RESOURCES & TEAMS

We have formed some organizational structure and outlines for future member resources and projects; an updated “Resources” page on our website reviews much of those plans. We have formed a number of teams for projects. Many more are in the pipeline. We will have a more formal list of those opportunities available soon. If you are eager to get more involved, the DPCA Slack page is a great place to start.

DIRECT VS. CAPITATION MANAGERS

Although the Alliance’s main focus is giving our members’ tools to help grow their practices, we also serve as an advocate for an authentic version of independent DPC practice. To do that, we must understand how the system around us is changing. Many of these things may influence the operations of DPC practices and our larger goals.

As our movement has grown and gained legitimacy, many outside parties-- people other than you and your patients-- are starting to recognize the amazing potential and far-reaching impact of the DPC model. These entities take many forms, including employers, organizations, brokers, consultants, managers of all sorts, insurance companies, and government agencies. Some of them are merely cheerleaders of our cause; while others are engaging in business directly with DPC practices.

Recently, a number of companies are attempting to connect large groups of patients with DPC practices; typically through larger employers or collections of employers. The basic function of these companies is to manage a portion of these healthcare dollars and subcontract out primary care services through networks of DPC practices. Structurally, these management companies are very similar to a traditional Managed Care Organization (MCO, e.g. Aetna or Coventry), but restricting their management to primary care. We don’t yet have a label for this type of company, but “Primary Care Management Organization” (PCMO) seems an apt description.

So what does this mean for DPC practices? In the next couple years, we will undoubtedly be given sales pitches of “We can bring your DPC practice 500 new members!” Sounds like a great way to grow a practice, but in the midst of these discussions, we must remember the core principles of Direct Primary Care and what truly distinguishes us from the status quo managed care system.

The essence of the DPC model has always been about putting our patients back in control of their health care, including their dollars. As much as we applaud PCPs being freed from red tape and bureaucratic distractions, just as importantly, DPC empowers patients. As a patient chooses us freely on our own merits and value, It’s the ultimate “engagement” tool that has long been missing. This direct, transparent partnership has tangible benefits that people not in the exam room often can’t comprehend or measure.

Given the modern nature of primary care, moving away from fee-for-service payments is a good thing. But the Direct Primary Care model is much more than clinics charging a flat monthly fee. In the purest version of DPC, a practice works exclusively for the individual patient as individuals; not for an outside company or plan managing the health care dollars of those individual patients, especially when these individuals are grouped together on a plan.

Historically, the latter is called capitation and not a new idea whatsoever.  Whether they be private (e.g. HMOs) or government organizations, capitation arrangements have traditionally been fraught with problems for primary care. Despite this, capitation proponents claim the next iteration will be better; promising to properly value primary care and minimize the administrative hassles.

Even if you are trusting enough to believe that, the PCMO concept is fundamentally adding a layer of management and cost to the simplest version of DPC. Some would argue it is not Direct Primary Care at all. Regardless, attempts to organize patients and practices through PCMOs is well underway.

CMS “DPC” PROJECT

CMS recently unveiled a “Request for Information” (RFI) for a potential “DPC” project. Unfortunately, CMS retooled the DPC acronym as “Direct Provider Contracting”. The warping of the DPC acronym was frustrating, but the content of the document was also met with much consternation and concern.

The RFI heavily references an existing Medicare payment model (Comprehensive Primary Care Plus, or CPC+) which is a partial capitation payment to PCPs. The payment methodology with CPC+ is complicated (120 pages) but slowly moving towards nearly full capitation with adjustments for “performance” (presumably via reported metrics).

In this context, CMS described their version of DPC as, “CMS would pay these participating practices a fixed per beneficiary per month (PBPM) payment to cover the primary care services”. The RFI also mentions “an opportunity to earn performance-based incentives for a total cost of care and quality.” If you are wondering how this description is much different than CPC+ program, so are we!

Further, the RFI discusses how the CMS version of “DPC” could or should (?) be combined with Accountable Care Organizations (ACOs). If you are not familiar with ACOs, the basic concept is that all providers and companies involved assume financial responsibility for a population of patients. If it sounds complicated to organize such a thing without red tape and moral hazards, that’s because it is. The adoption and promised savings of ACOs are falling way short of expectations despite heavy investments from the federal government.

In the 9 pages of the RFI, there is only one brief mention of “direct primary care”; described as “where physicians or practices contract directly with patients for primary care services.”

Although the tone and content of the RFI were disappointing, the CMS project is still in the early stages of formation. We will continue to engage in this process to make sure your voices are represented and encourage our members to do the same. In the coming weeks, we will be sharing a full detailed response to the RFI, including suggestions to create truly patient-centered options for people to choose innovative models like DPC.

ADVOCACY & PROFESSIONALISM

As the Alliance and DPC community engages in advocacy within a changing landscape, we want to affirm that the Alliance believes in collaboration and professionalism per the ABMS standards. We recognize and respect that our members have many different views on matters related to DPC and other issues. Our passion and diversity of views can cause friction at times among each other and when interacting with other organizations.

Even when not officially representing the Alliance, we encourage our members demonstrate that we are esteemed, educated, compassionate, and thoughtful professionals. We must remain mindful that unprofessional behavior can be destructive to the Alliance and the DPC movement’s larger goals.

PRIMARY CARE ENHANCEMENT ACT & LOBBYING

There are many individuals and organizations still pushing for the Primary Care Enhancement Act  (HR 365) to be passed in the U.S. Congress. This Act will clarify a few matters regarding Health Saving Accounts (HSA) and membership in a DPC practice. The bill now as 30 cosponsors in House and remains bipartisan.

The DPC Alliance is not a political or lobbying organization but we recognize many of our members will engage in such activities as individuals or as part of other organizations. We encourage members who desire to be involved with legislative process around Direct Primary Care (including HR 365) to inform themselves about options for involvement through organizations designed for such activities. A few of these options that have lobbied on behalf of DPC matters include state medical societies, DPC Coalition, AAPS, AAFP, ACOFP, AID, AMAC, PWT, and NFIB.


Sincerely,

DPC Alliance Board of Directors

Member spotlight - Lisa Davidson, DO

Hey hey hey! It's Wonder Member Wednesday!

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Today it is our privilege to highlight the feisty, vibrant Lisa Davidson, DO. Dr. Davidson is a member of the DPCA Advisory Committee and a DPC pioneer. She launched Insight Primary Care in 2012 in Denver, Colorado joined by Melissa Jones, PA-C. They share a practice and have been at capacity for the last few years, taking new patients by wait-list only.

Dr. Davidson is a physician advocate and believes in work-life balance. She continues to modify the services at Insight to forge a sustainable, transparent DPC model.She believes DPC provides the opportunity to design a practice that allows you to serve your patients and care for yourself.

Dr. Davidson is one of the leads of Rocky Mountain DPC Alliance and was integrally involved in the passage of DPC legislation in Colorado in 2017.

Advocate, pioneer, entrepreneur, lobbyist, leader, doctor, mother, friend. . . Dr. D- we salute you!

Find her here:

http://www.insightprimary.com

#proudtobedpca #doctorswhodo

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Member spotlight - Rob Rosborough, MD

Dr. Rob opened Township Health DPC in Silverton, Oregon one year ago yesterday after turning 50 and spending more than 20 years in the traditional health care system. (Happy one year + one day birthday!!)

His frustration and 'disgust' with the system he was in outweighed the fear of entrepreneurship and starting over.

Dr. Rob is adding a partner, growing like crazy, practicing with 2 staff that have been with him more than 20 years and states, "DPC saved my professional career and made it better than I ever thought possible. I am a Family Doctor and I'm damn proud"

We're damn proud of you, Dr. Rob. Keep showing us all what high quality, authentic family medicine really looks like.

Find Dr. Rob here: http://townshiphealthdpc.com

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Member spotlight - Amber Beckenhauer, MD

Dr. Amber Beckenhauer! Dr. Beckenhauer grew up in Nebraska with a vision for comprehensive birth to death old-fashioned family medical care.

After residency Dr Beckenhauer found that with all of the paperwork, meetings, charting, and other duties, she had very few moments to truly enjoy her patients or the art of doctoring. She came to a crossroads where she felt like she had two choices:

"go down in flames and never see my family or patients again for longer than 15 minutes or... join the DPC docs that I respected on Facebook and follow in their footsteps."

We are so excited she picked option 2!

Welcome to The Healthy Human DPC located in Blair, Nebraska.

Two months in and Dr. Beckenhauer and Melanie Dresden, APRN have 181 patient members.

She states: "even though I went from a salary to none, my life is at its fullest. You have to find what matters most and then build everything around that."

Learn more about The Healthy Human and Dr. Amber at: https://www.healthyhumandpc.com

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Member spotlight - Jennifer Harader, MD

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Dr. Harader co-founded Oasis Family Medicine in March 2015 with Holly Cobb, APRN-C after strategic and amicable negotiations with her then-employer. Oasis started with 289 patients and 3 staff. Today (3 years later) they employ 6 staff and care for >1550 patients!

Oasis's has not only been a resource for fantastic primary care but in 3 years has also provided more than 19,800 in-house medication fills, 400 imaging studies and more than 5000 labs at wholesale pricing, saving patients time and money.

Dr Harader explains, "our success is based on creating the type of practice we would want to be part of. Also the grace of God and some dumb luck. 🙂 Our biggest hurdles are ... the challenge of what to do next, as our practice is ready to grow again and we need to find the right person to join our team."

Lear more at: https://www.oasisfamilymedicine.net

Member spotlight - Delicia Haynes, MD

Dr. Haynes started a solo practice straight out of residency in 2009 and transitioned her practice to DPC in 2015.

Recognition includes her local Chamber of Commerce's Small Business of the Year award (2016), 40 Under 40 Young Professional of the year (2018), and the recent election to President of Volusia County Medical Society. She is both the youngest and first Black President.

Dr. Haynes gives back through motivational talks in the DPC space, through programs like "Cut High Blood Pressure" - a community initiative to teach barbers and stylists to screen for hypertension, annual free sports physicals (8 years running!) and in talks about physician suicide and depression.

Find her here: http://familyfirsthealthcenter.com/meet-dr-delicia/

#proudtobedpca #doctorswhodo

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