A Disruptive Practice: Lawmakers Consider Direct Payments To Primary Care Doctors

Apr 10, 2015

Dr. Garrison Bliss established his company, Qliance in 1997 to pioneer a new model for paying for healthcare.
Credit Qliance.com

It’s a year of disruption in Florida. Bills targeting the ride-share service Uber, and the room share system Air B&B are moving. Craft Brewers are challenging major distributors for dominance and now some doctors are getting in the disruptive spirit by kicking traditional health insurance to the curb.

Primary care is considered the front-line of medicine. The idea is simple. Treat people before they get sick, keep them healthy, and out of emergency rooms. But the number of primary care doctors is shrinking. They make less than specialists and carry a greater workload. And according to a Kaiser Health News survey, the state needs more than 900 primary care doctors to meet current demands. And Dr. Garrison Bliss says primary care doctors are stressed.

"If you take a look as a medical student at your options, one of the things you’ll discover is you can go into a number of specialties, and do very exotic and sexy work," he told the House Health Innovation Committee back in February. "Or you can come into primary care, see 25-30 people a day, and at the end of the day go home and put your head on ice, and get paid a  third as much as everybody else.”

Bliss, a Seattle-based physician was talking about a concept he now uses in his practice--direct primary care. The idea behind it goes like this. A person plays a flat monthly fee, and gets to see the doctor when he or she needs to. It eliminates the insurance company—and also gets rid of payments based on items like tests, labs and procedures. So far, Bliss says it’s working out well for him.

“We get paid once a month, and that’s all we get paid. We don’t need money from anyone else. We don’t have to make our money by doing things to patients. We don’t have to come up with exorbitant diagnosis and treatments in order to facilitate our work. We can work with a healthy person who wants to stay healthy, and get paid. And it’s a pretty interesting way of doing it.”

“Direct primary care is a disruptive innovation that breaks the mold," said National Federation of Independent Business-Florida's Tim Nungesser.

He and other supporters say direct primary care challenges traditional health insurance, where doctors are paid a fee for services rendered. Direct Primary Care also results in more money for the doctor, because the middle man—the insurance company, is out of the picture. Businesses like the concept because they see it as a cost savings. Nungesser notes a key caveat—direct patient care does NOT replace the need for insurance, but can work with it.

“A direct primary care, coupled with a major medical policy, satisfied the employer mandate for ObamaCare," he testified before a recent Senate panel considering the issue.

The legislation makes clear direct primary care is not insurance—both for patient disclosure purposes, and for state regulatory clarity. The House and Senate bills are nearly identical, and both include an unrelated effort to market Florida as a destination for Medical tourism. That’s supported by Patty Holland, who represents the Medical Tourism Association.

“Medical tourism is five to tens times tourism alone. So the economic impact is greater.”

Plans to fund marketing efforts promoting medical tourism had been languishing, but are getting a boost due to their attachment to the direct primary care proposal.

The combined proposal is generating bipartisan support as they move through the legislative process.