Protecting the Private Practice of Medicine: Direct Primary Care - Louisiana Poised to Lead
Sabrina L. Noah
Examiners (LSBME). 2. A group of MDs or ODs, licensed to practice medi- cine by the LSBME. 3. An entity that sponsors, employs, or is affiliated with a group of physicians. That entity must be wholly owned by physicians or a 501(c)3 nonprofit. That entity is not prohibited from being affiliated with other providers who do not provide direct primary care practice. However, the group must provide direct medical care services and not any research, technological, operational, or administra- tive support. A DPC is defined by its operating practices, including: 1. Entering into a direct agreement with patients. 2. Collecting a direct fee from patients. The practice charges a direct fee on a periodic basis, agreed upon and stated in the direct agreement, which represents the total amount due for all primary care services. 3. Does not accept payment for healthcare services provided to patients from any insurance entity. 4. Does not provide any procedures or supplies for hospitalization, surgery, dialysis, high-level radiol- ogy, MSI, rehabilitation services, procedures requir- ing anesthesia, or similar advanced procedures. 5. A DPC can accept payment of the direct fees, di- rectly or indirectly, by third parties. An employer can pay the fees associated with a DPC for their employees but cannot enter into a direct agreement with the employer. 6. DPC direct agreements may not be sold to a group or “entered with a group of subscribers.” It may only exist between the practice and the individual patient or family of direct patients. 7. A DPC can accept payments from the Louisiana Medical Assistance Program if approved by the Centers for Medicare & Medicaid Services. A DPC is required to: 1. Maintain appropriate accounts and payment his- tory. 2. Allow patients to pay their monthly fees ahead of time, but they must be held in trust, and any un-
This is the fourth and final 2014 installment in our series that reports on emerging trends and new practice models in medicine. As we discussed in our April editorial, “Direct Primary Care: Kicking Insurance Out of the Exam Room,” the new primary care practice model known as direct primary care (DPC) is posed to force an evolution of the healthcare sys- tem in Louisiana. DPC practices offer a membership-based approach to routine and preventive care, whereby patients pay a low monthly fee, typically $49 to $100, to their physi- cian for all of their everyday health needs. DPC practices do not take insurance; therefore, there is no need for billing approval, deductibles, or co-payments. With lower overhead and dramatically less paperwork, providers have the time to deliver high-quality care instead of managing insurance claims. As of our April article, the Louisiana State Medical So- ciety had introduced legislation, Senate Bill 516 authored by Senator Sherri Buffington and Representative Stuart Bishop, to make it possible to operate a direct primary care practice in Louisiana. Prior to this law being enacted on August 1, 2014, direct primary care practices would be subject to laws that regulate insurance companies because of their prepay model. After near unanimous support in both the house and senate, SB 516, now Act 867, cleared the regulatory path, allowing DPC practices to begin operating in Louisiana. In order to further educate our members about this important legislation, we have drafted a detailed summary of the legislation in hopes of expanding this practice model statewide. ACT 867: DEFINITION AND FUNCTION OF A DIRECT PRIMARY CARE (DPC) PRACTICE A direct primary care (DPC) practice is defined as one that charges a fee to a patient to provide routine healthcare services, including screening, assessment, diagnosis and treatment for the purpose of promotion of health, and detec- tion and management of disease or injury. A DPC can be operated by: 1. A sole proprietor MD or OD, licensed to practice medicine by the Louisiana State Board of Medical
J La State Med Soc VOL 166 September/October 2014 217
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