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Direct Payment Models

Starting to Gain Traction

with Physicians, Patients Broader reach.

Every day, 10,000 Baby • Reduced patient vol-
Boomers turn 65 and ume Expanded service.
become eligible for • Fewer medical errors
Medicare. A generation • Elimination of insur-
numbering 77 million ance filings
boomers are showing up • More time for patient
in the offices of primary care
care physicians more and The concept is starting
more as the effects of aging to gain traction. Since
lead them to seek even Congress passed the
greater medical attention. Affordable Care Act in
Caring for boomers — 2010, the number of
like all patients — is part physician practices with a
of a doctor’s sacred calling, BY KEVIN N. FINE direct-payment model has
but the reams of paper- slowly grown to more
work and billing than 600, according to the
headaches that accompany them threat- Direct Primary Care Coalition. Dozens of
ens to overwhelm the office staff of not such practices have spread throughout
only solo physicians, but larger practices Florida. Trying to encourage more
as well. growth, the Florida Legislature passed a
Adding additional staff to manage the law that took effect in July exempting
administrative burden due to the grow- direct-payment arrangements from any
ing onslaught of boomers and increasing regulations under the state insurance
regulatory pressures may not be enough code. Collaboration leads to greater resources for you. That’s why Broad and Cassel
for a practice to survive and thrive going The Centers for Medicare & Medicaid has partnered with Nelson Mullins to become a firm with more than 725 legal and
forward. Relying on yesterday’s solutions Services (CMS) announced earlier this business professionals working in 25 offices across 11 states and Washington,
rarely work today, much less in the year that it would develop a potential DC. The combined firm’s goal is to contribute to your success through added In Florida, known as Nelson Mullins Broad and Cassel
Attorneys and Counselors at Law
future. direct payment model within Medicare capabilities, enhanced practices, and broader geographic reach.
Now might be a good time to explore and Medicaid programs, enabling
alternative reimbursement structures providers to contract directly with CMS 163 Attorneys named 2018 100+ Ranked in the top 100 largest U.S. law firms
nelsonmullins.com
such as direct payment. Direct-payment and share accountability for costs and Best Lawyers in America Practice Areas in 2017 and 2018 by The American Lawyer
models, which are starting to gain quality of care. “Such a model would
acceptance across the country, enable have the potential to enhance the doctor- SOUTH FLORIDA:
One N. Clematis St., Ste. 500 251 Royal Palm Way, Ste. 215 7777 Glades Rd., Ste. 300 100 S.E. 3rd Ave., Ste. 2700 2 S. Biscayne Blvd., 21st Floor
physicians to deal directly with the patient relationship by eliminating West Palm Beach, FL 33401 Palm Beach, FL 33480 Boca Raton, FL 33434 Fort Lauderdale, FL 33394 Miami, FL 33131
patient for payments, without having to administrative burden for clinicians and 561.832.3300 561.659.8661 561.483.7000 954.764.7060 305.373.9400
go through an insurance provider. providing increased flexibility to provide
the high-quality care that is most appro-
Direct-payment model example priate for their patients, thus improving
Though these models and fee struc- quality while reducing expenditures,”
tures will vary, here’s an example of what according to the CMS press release.
a direct payment model might look like:
The patient pays a primary care physi- The future for alternative
cian an introductory charge, plus a reimbursement
monthly fee, maybe somewhere in the The adoption of alternative reimburse-
range of $70 a month, with yearly rates ment structures and increased efficiency
around $850, depending on the number of the overall health system will take
of visits and services offered. This fee time. As healthcare providers move away
covers most primary care services. from the longstanding fee-for-service
Children under 18 could be added to the approach and toward value-based care,
plan for, say, as little as $240 annually. direct-payment models and other struc-
Patients worried about major health tures could become increasingly attrac-
issues, such as cancer or a car accident, tive to providers who are willing to take
could also carry a separate high- on more risk in exchange for the benefits
deductible insurance policy that would mentioned above. And while current tax
have relatively low monthly payments, laws are not especially favorable for
but provide coverage for catastrophic patients participating in direct-payment
events. models (i.e., fees cannot be deducted on
a pre-tax basis), that may change.
Gaining traction with support Direct payment has the potential to
from AAFP, CMS become the payment model of choice for
Without having an insurance carrier as more physicians as the healthcare land-
a financial partner, physicians participat- scape continues to evolve. Providers who
ing in the direct payment model are tak- want to learn more about alternative
ing on a form of risk that is similar to a reimbursement structures can contact a
capitation payment model, but without qualified healthcare consultant who can
the ability to share that risk. However, provide insight into industry changes
with risk can come reward, and health- and how those trends may impact their
care providers have the potential to ben- practice.
efit from direct payment in many ways.
The American Academy of Family Kevin N. Fine, MHA, is a director of
Physicians supports the direct-payment healthcare advisory services in the Miami
concept, citing the following advantages: office of Kaufman Rossin, one of the top
• Lower overhead accounting firms in the U.S. He can be
• Improved collection rates reached at kfine@kaufmanrossin.com.

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South Florida Hospital News southfloridahospitalnews.com August 2018 9