They’re legal and unregulated in Virginia, but concerns that the practice may be attacked, or regulated like insurance, led to pre-emptive legislation this year. A handful of states have similar laws, and the idea generally has conservative backing.
By Travis Fain
MARCH 6, 2016 | RICHMOND, VA – There’s an emerging new model in primary care, and legislation to protect it has sparked a fight this session with Virginia’s insurance industry.
The idea is for patients to pay primary care doctors a monthly fee and get an agreed-upon set of services in return. It’s basically a subscription, and it’s called a “direct primary care agreement.”
They’re legal and unregulated in Virginia, but concerns that the practice may be attacked, or regulated like insurance, led to pre-emptive legislation this year. A handful of states have similar laws, and the idea generally has conservative backing.
The insurance industry sees too much potential for double billing in the practice and argues that these agreements should be regulated. House Bill 685 made it out of the House of Delegates 97-0 last month, but it narrowly cleared committee in the Senate after industry concerns were aired.
Now it’s awaiting debate on the Senate floor.
The bill would make it excruciatingly clear that these agreements are not insurance. They couldn’t be regulated by the state, they wouldn’t require licenses to sell and they’d come with a disclaimer suggesting that patients buy insurance for “services not provided by the direct primary care practice.”
The disclaimer would also tell patients that having this agreement won’t satisfy the Affordable Care Act’s requirement that people have insurance.
Patients could terminate agreements at will, the bill states, and get back any money they pay in advance. Agreements could only be used for primary care services, and doctor offices would be forbidden from billing insurance companies for services covered by the agreement.
But this protection against double billing is not strong enough, according to Reginald Jones, who lobbies for a number of insurance groups and is fighting this bill in the Senate. George Clark, a Newport News insurance broker who follows the General Assembly, said the idea sounds “all good on paper but it’s not quite ready for law.”
“The wording is very loose and patients will get hurt,” he said after reading the bill.
Clark noted that the Affordable Care Act requires insurance to cover preventative care free of charge, and that monthly subscription fees wouldn’t count toward out-of-pocket maximums in insurance plans.
Dr. Jesus Lizarzaburu, in Yorktown, said primary care isn’t always classified as preventative, and high deductibles mean patients end up paying, even with insurance. Plus, he said, doctors who want to provide flexibility, by answering questions over email or handling some visits via online video chats, don’t have a way to get paid for those services under insurance agreements.
“For us to get paid we need to see you,” Lizarzaburu said. “And that’s extremely pervasive.”
Lizarzaburu likened these agreements to keeping a lawyer on retainer. They help cover the time doctors spend on incidental services without jumping through the hoops, and hitting the walls, that come with insurance companies. A lot of times these agreements run $50 or $75 a month, distinguishing them from so-called “concierge medicine” he said.
“People pay $120 a month for a phone,” Lizarzaburu said. “I don’t think, particularly, that this is a very elusive idea.”
Jones said there may be a place for direct agreements in Virginia’s health industry, but the practice should be regulated. Where, he asked, can patients turn if they have complaints?
To their doctors, with whom they likely have a good relationship, said Hunter Jamerson, who lobbies for physicians at the Virginia General Assembly. If that doesn’t work, there’s always the courts, Jamerson said.
Del. Steve Landes, R-Verona, is carrying House Bill 685, which has support from the National Federation of Independent Business. Landes said the bill is needed so nobody can question the legality of these agreements.
His legislation made it to the Senate floor on an 8-6 committee vote Monday, but it’s been sitting since, getting passed by two days last week instead of getting a final vote. The same Senate committee set aside a companion bill, Senate Bill 627, earlier this session so the idea could get more study.
House and Senate committees tend to treat companion bills the same way, which is one of the reasons senators were hesitant to advance Landes’ bill after delaying their chamber’s version of it.
Fain can be reached by phone at 757-525-1759.
SOURCE: http://www.dailypress.com/news/dp-nws-ga-primary-care-agreements-20160306-story.html
