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Florida: Direct Primary Care Makes Its Debut

Direct Primary Care (DPC) is finally authorized too. claimers required the DPC bill exposes
here in Florida. Florida joins the grow- Insurance or Not? It is significant to that there are severe limitations on
ing trend of states – up to 25 now - realize the reason the statute is needed using it as a standalone DPC product
who have adopted this “new” payment is because Florida’s Office of Insurance to meet the Obamacare mandatory
model. Some of you will recognize it as Regulation takes the position DPC is health insurance requirements. A con-
your old friend capitation but without insurance. There was a real regulatory sumer just purchasing a DPC product
the HMO. But overall, it will allow for concern that such arrangements need will not meet their health insurance
entrepreneurs and innovators to have to meet the licensure requirements for purchase mandate. As a result a DPC
one more option to create exciting new a Prepaid Health Clinic. Licensure cannot be listed on the government
medical business models. would require significant capital healthcare exchange as a stand-alone
Statutory Requirements. The bill reserve funds to be held, application product. But, as we all know, Obama
provisions are rather simple and not and obtaining approval for licensure care is being repealed by the free mar-
very complex. It will create a new and engaging in at least annual report- ket, anyway, and the exchanges are
Florida statute under the insurance ing. All those requirements are avoided floundering.
code – section 624.27. What the bill by DPC not being classified as insur- BY FRANK P. RAINER, As all things in health care, the
allows is direct contracting between a ance. ESQ. details matter. Great care will be need-
health care provider and a patient or Taxes … Deductions and Credits. ed in structuring and marketing the
the employer of the patient. The physi- DPC does ask the consumer to pay the account are untaxed, and when the DPC product. Even greater care will be
cian and the patient can contract for a somewhere between $1,000 to $2,000 payments are used for qualified med- needed to structure an economically
monthly fee arrangement for care serv- a year for payments. Unfortunately for ical expenses, then there is still no viable product that can take advantage
ices on a scope and frequency the par- the consumer, payment may not be tax income to be taxed upon. of tax and employee benefit planning,
ties agree to. There are some rather deductible, since the payment will for But … as in all things tax, the devil is so payments can be made and deduc-
simple requirements for this contractu- most people not reach the threshold as in the details. The IRS has come up tions taken. There is a feeling of great
al relationship which are meant to an itemized tax deduction (7.5% of with a very tortured reasoning to pro- opportunity available to develop DPC
avoid confusion or provide disclosures. adjusted gross income). hibit DPC payments being eligible for products, and that it is just a matter of
Doctors, Chiropractor and ARNPs. Health Savings Accounts. payment out of an HSA. While the IRS carpe diem. DPC is a good idea whose
All Medical and Osteopathic Doctors, Recognizing the lack of tax appeal is not tested on the matter, a state law time has come.
Chiropractors and APRNs can take (especially for higher income individu- recognizing the payment as “not insur-
advantage of this model. They can do als), the holy grail of DPC programs is ance premium” should be compelling.
these contracts as solo, group or corpo- to have a DPC program as a benefit Given the tidal wave of states adopting Have questions?
rate practices of medicine business which is paid out of a health savings this law, the IRS will have to relent on You can contact Frank Rainer, Esq,
organizations. Health Clinics which are account (HSA). Under an HSA, the its illogical position. Senior Counsel, Broad and Cassel, at
majority practitioner owned are employer’s or employee’s deposits into Exchange Worthy? One of the dis- frainer@broadandcassel.com.

Emergency Room Concerns, Meet Solutions in Direct Primary Care

As politicians and law and the need for hospi- access to get their providers real time opin- toward patients. More and more, patients
makers are wrestling over tals and their emergency ions even if it is at night or the weekend. are having to pay out of pocket for their
which health policies will rooms to coordinate with With the recent acknowledgment that prescription medications. This is creating
best serve our country, our local DPC practices in DPC is not insurance, we are now able to a financial burden on individuals and fam-
hospitals in South Florida their communities. This work more seamlessly with insurance ilies who rely on daily prescription drugs
are facing a rising crisis of would immediately cre- companies to achieve High-Value care in to manage conditions and illnesses such as
inappropriate use of ate more access to quali- our communities. hypertension, diabetes or ADD. People are
Emergency Rooms (ER). ty healthcare for unin- Health insurance premiums are rising in put in the difficult position of deciding
This crisis is directly related sured people while cost and families are having a more diffi- whether or not they can afford to buy their
to the increased number of simultaneously provid- cult time paying for these plans. Therefore, medications for that month.
uninsured and underinsured ing people in the com- it has left many Americans without health Is there a workaround? A different solu-
individuals who seek pri- munity 24/7 access to insurance. tion? A better system?
mary care services in the ER their providers. The deductible is what’s required as the Direct Primary Care (DPC) offers
or who have waited until BY DR. SIDNEY COUPET , To understand some of patient’s financial responsibility prior to American families a membership-based
their uncontrolled chronic DO, MPH, MSC DPC’s simple innova- the health insurance covering a specified system in which they receive affordable
diseases cause complica- tions will give us the percentage or 100% of the healthcare serv- primary healthcare services. DPC clinics
tions before seeking medical attention. understanding of how it can be considered ices. The deductibles tend to go up when grant patients access to their doctors with
Although the true causes for the as part of the solution for the crisis the people select coverage that is less compre- no co-pay, use of affordable labs and radi-
increase in the number of uninsured peo- hospitals in our communities are facing. hensive. In other words, the smaller your ology testing, and medications at lower
ple around the country is politicized, in The simple DPC innovation of providing premium, the higher your deductible. costs.
our South Florida community we can all its members unlimited access to office vis- Deductibles for the ACA’s programs are DPC does not replace health insurance.
agree that the rising number of the unin- its with no co-pay has created a sense of extremely high and are often unbearable It is a companion to it. DPC takes care of
sured is due to the following: reassurance and unapologetic ability for for low- to middle-income families. basic health care at affordable prices, leav-
1. People’s inability to afford the rising patients to have same day or next day Deductibles as high as $6,000 or more beg ing health insurance to cover more spe-
premiums of health insurance appointments with their providers. the question: why carry health insurance cialty services and catastrophic events/ill-
2. The high deductibles associated with Chronic diseases are better managed with at all? nesses.
accessing primary and preventative more timely and effective medical inter- Co-Pay is the payment required for Coupet Quality Clinic (CQC) operates
healthcare services ventions with every visit. This prevents a office visits of any kind or axillary services on the Direct Primary Care medicine
The combination of the above has creat- crisis and ultimately avoids a preventable such as labs, radiology tests and some- model with an Extensivist who provides
ed this crisis of increased inappropriate visit to the emergency room. times medications. Patients must pay this high level care coordination and is a liai-
use of ERs in our communities and hospi- Another DPC innovation is the ability to amount prior to any services being ren- son to many specialist physicians, in order
tals that are in the frontlines are left to deal have 24/7 access with enhanced commu- dered. Co-Pays are potential barriers to to manage the high-risk patients in our
with this crisis. In addition to affordability nication with providers via text messaging accessing health care. For instance, a per- community and to keep them from getting
there is also the inability to access care in and video chatting that also creates an son may not be able to afford a $50 co-pay readmitted to the hospital.
a timely fashion which occurs very fre- opportunity to reduce unnecessary visits to see their doctor once, let alone multiple
quently with underinsured people in our to the Emergency Rooms. Patients that are times (for example, for repeat visits to get
community. enrolled in a DPC practice are not left blood pressure under control). For more information, call Coupet Quality
We are proposing Direct Primary Care alone to negotiate their urgent healthcare The prices of medications are rising, and Clinic at (786) 207-4788 or visit
(DPC) as part of the solution to this crisis needs or concerns and now have the insurance companies are shifting the costs www.coupetqualityclinic.com.

6 June 2018 southfloridahospitalnews.com South Florida Hospital News