State lawmakers are working on legislation that would regulate direct primary care clinics in an effort to bring more affordable primary care to patients in Wisconsin.
Rep. Joe Sanfelippo, R-New Berlin, said rising insurance deductibles the Affordable Care Act created cause doctors to take on more patients to make money, which means less time with a doctor for each patient.
Direct primary care clinics offer patients access to primary care without having to use their insurance plan, Sanfelippo said.
“What we’re trying to do is get some affordable options out there so people can have access to primary health care without being worried about how they’re going to pay for it,” Sanfelippo said. “In many cases, even individuals who do have insurance the deductibles and copays are so high that they are reluctant to use their insurance coverage just because they can’t afford to.”
In a direct primary care clinic, a doctor offers their services to patients for a flat monthly fee. This fee gives patients access to their primary care doctor without having to use their insurance deductible, which could save patients money if they never need to use their insurance plan, Sanfelippo said.
This approach to primary care also gives patients more time with their doctor, Sanfelippo said.
“On average, right now, doctors spend seven minutes in an exam room with a patient and then another 30 to 40 minutes just filling out paperwork afterward,” Sanfelippo said. “Under [the primary care] model, doctors are spending 30 to 60 minutes in the exam room with a patient. They get to know their patient intimately which ends up in better care for the patient. A lot of these doctors do home visits, so it’s kind of like old-fashioned medicine — the way that it used to be before all the red tape got involved.”
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Direct primary care contracts are becoming more common, but there are no regulations to govern the practice, Sanfelippo said.
The legislation will acknowledge direct primary care clinics as a form of health care and regulate the practice to make doctors feel more comfortable, Sanfelippo said.
“Some doctors have done it,” Sanfelippo said. “Many doctors would like to do it, but they’re apprehensive to do it because there are no rules that govern the practice. What we’re doing is trying to make it so doctors feel more comfortable to get into this type of a practice.”
Regulating the practice may bring more doctors to direct primary care contracts, but these contracts are not a replacement for health insurance.
Doctors offering primary care contracts still recommend their patients have major medical insurance to cover hospital visits and protect against potential catastrophes, Sanfelippo said. Communication between patients and their doctor is clear on what is and is not included in the contracts.
“The only downside would be any type of misunderstanding, but in the bill we’ve taken many precautions for our consumer protection so that we are taking every step we can to make sure the people who get involved with these contracts know exactly what they are, what they aren’t and what their rights are,” Sanfelippo said.
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The clinics offer access to a primary care provider, but patients will still need insurance to handle specialty care such as imaging services, prescription drugs, referrals and hospitalization, said University of Wisconsin Population Health Institute researcher Donna Friedsam.
These clinics also take patients out of an integrated health care system, Friedsam said.
“Most health care providers in our state are affiliated with integrated delivery systems and appreciate being able to enroll a patient as part of a continuity of care plan where they have access to specialty services and referral services within a system,” Friedsam said. “For them, I don’t know if they’re really interested in seeing this kind of direct primary care model that takes them out of the integrated care delivery system.”
Taking patients out of this integrated system does not address the overall problem of rising deductibles and insurance costs, Friedsam said.
The clinics and the legislation allow people to stand outside of the insurance system to receive primary care, but do not address concerns for the whole population, Sanfelippo said.
“It isn’t quite clear what the problem is that the legislation is trying to fix,” Friedsam said. “It may work on the margins for some people, but it is not a population-level solution and it doesn’t bring us forward in addressing the overall ingrained problems of cost, coverage and access for the population as a whole.”
