Dr. Fisher: A solution for rising health care costs

Dr. Kenneth Fisher

Perhaps the only thing more elusive than the Loch Ness Monster is the solution to America’s rising health care costs.

After decades of federal government reforms aimed at our nation’s health insurance market, most recently with the Affordable Care Act, the United States still touts the highest per capita health care spending in the world.

That’s why it’s encouraging to see state-level reforms like Michigan’s Public Act 522.

Written by State Sen. Patrick Colbeck and signed into law by Gov. Rick Snyder, PA 522 facilitates physician participation in a new and dynamic health care model that serves as an alternative to the traditional insurance-based practice of old: Direct Primary Care (DPC).

DPC resembles a club membership. Rather than using health insurance to pay for each and every doctor’s appointment, patients instead pay a flat monthly fee, usually between $50 and $125, for their primary care needs and heavily discounted outpatient testing.

This innovative practice model has the potential to transform the way we think about health care. The early evidence is overwhelmingly positive. When patients have the freedom to make their own health care decisions, health care spending goes down while health outcomes improve.

These benefits are especially pronounced in patients afflicted with chronic conditions.

A recent study published in the American Journal of Managed Care found that a single collective DPC group was able to produce savings of $120 million in just one year, averaging $2,551 per patient.

Another study published in the British Medical Journal found DPC patients had 35 percent fewer hospitalizations, 65 percent fewer emergency department visits, and 82 percent fewer surgeries than similar populations.

In 2005, there were only 146 physicians in the U.S. utilizing this practice model. By 2010, that number had more than quintupled to 756. And in 2012, two years after the passage of the health overhaul, there were 4,400 physicians nationwide who chose DPC over the traditional insurance-payment model.

The growth between 2010 and 2012 is noteworthy because it shows physicians’ growing frustration with the Affordable Care Act.

Every physician I know entered the field of medicine because they wanted to build healing relationships on a very human level and improve patients’ health over time. That has become increasingly less possible under the act.

Removing insurers and government from the health care equation allows physicians to focus exclusively on the needs of their patients without having to consider external factors like whether certain policies cover certain treatments and so forth.

But despite these benefits of DPC, various federal policies are nonetheless restricting their expansion.

For instance: tax laws dealing with Health Savings Account (HSA) eligibility, lack of option to pay for DPC from HSAs, and potential conflicts with Medicare are hurdles that must be overcome.

There also remains abundant uncertainty with how DPC fits into the regulatory maze that is the Affordable Care Act, and as a result federal action is needed so that more physicians and businesses can participate.

Federal lawmakers should look to PA 522 as an example of how to clear confusion about the treatment of Direct Primary Care at the national level. Removing DPC from consideration as a health insurance product enables it to continue evolving in ways that will lower costs, improve health outcomes, and — most importantly — return health care decisions to patients.

Dr. Kenneth Fisher, a nephrologist, is the president of the Michigan chapter of Docs4PatientCare.