In this webinar, originally live-streamed on March 26, 2020, Jay Keese, Executive Director of the Direct Primary Care Coalition, provided updates on congressional legislation and executive actions that will permanently reshape the US healthcare system. Jay actively works with members of Congress to ensure that Direct Primary Care practices have a voice in the federal response to the COVID-19 pandemic.
Watch for Yourself
Q: What legislation is included in the CARES Act, and how will it affect Direct Primary Care?
A: The CARES Act is the largest stimulus in US history. And while there are numerous employment incentives and tax relief measures included in the bill, we’re going to focus solely on the health policy that will inevitably affect Direct Primary Care. It’s fair to say there’s more health policy being implemented here than on any legislation since the Affordable Care Act, and there will likely be more that will come out of future bills.
In this bill, both Congress and the Administration have done all that they can to remove barriers to providing virtual care. The bill waives or temporarily suspends enforcement of every telemedicine restriction, including a general waiver on HIPAA, during this crisis. Also, until the end of 2021, companies are allowed to offer a telehealth benefit to employees with an HDHP linked to an HSA, and it would not make them ineligible to fund their HSA. This presents a good opening for future talks about the benefits of DPC, and we’ll work with CMS to see if we can try to expand these policies. In the next round of bills starting in mid-April, we’re going to push to make some of these temporary changes permanent.
Q: What proposed policy changes were tabled?
A: All of the Medicare programs that needed to be funded were postponed to November 30, 2020, and two key items on the agenda were tabled: 1) a surprise billing package that has been pending for over a year, and 2) prescription drug legislation. It’s highly likely that talks about both will continue.
Unfortunately for DPC, the Primary Care Enhancement Act was also removed from the bill because of an objection on the part of Ron Widen (Senate Finance Division) and his staff at the negotiating table. This objection was based on the antiquated notion that DPC offers only concierge services benefiting the wealthy. This misunderstanding of the offerings and benefits of DPC can only be resolved as we educate lawmakers in the coming months.
In addition, under this current law, 23 million Americans who have a High Deductible Healthcare Plan linked to an HSA are still legally ineligible to have an arrangement with a DPC practice. We will keep pushing for a change in this legislation in future policy talks.
Q: Since the PCEA provision was tabled, should we pivot to support for the Personalized Care Act legislation?
A: PCEA is the only piece of legislation that only addresses the DPC issue. There are several other bills dealing with healthcare policy, but none of them address the greater issues that affect Direct Primary Care and the way we operate. We’re working to support any bill or legislation that opens the door to expand DPC, but we don’t want to give up on the PCEA provision just yet. We are confident that we could get new legislation passed by the end of 2020.
Q: Have restrictions been eased when it comes to providing care across state lines?
A: Despite the President’s announcement that, under the Stafford Act, he would allow doctors and nurses to practice across state lines, he does not have the authority to lift those restrictions. As a result, on Tuesday, Secretary Alex Azar sent a letter to 50 state governors asking each to make this decision about whether they’ll allow out-of-state doctors to practice in their state boundaries. As of last Friday, about one-third of the states have implemented policy changes to give more freedom to medical professionals during this pandemic.
Q: Have there been any hearings on DPC/HDHP-fix?
A: We had a hearing and a mark-up in the Ways and Means Committee last October and a full hearing on the HSA bill from last year as well. However, there has not been a Senate hearing on this topic.
Q: What kind of executive action or legislation do you expect to see in the coming weeks?
A: Now that we’re expanding into the digital health arena, we’re going to see security issues arise with patient-facing telemedicine apps. I think that this will lead to a massive expansion of privacy laws so that telemedicine can be practiced securely.
I also expect a second round of healthcare policy reforms to be finalized in the coming weeks, another massive stimulus for our struggling economy, and full authorization of the HRSA telehealth funds to help companies improve bandwidth to serve more patients.
Q: There’s been talk about providing free COVID-19 tests for all in the near future. What does the latest legislation say about testing?
A: The bill that passed on Thursday states that any private or government health plan must pay for screening, testing, diagnosis, and treatment of COVID-19 without copay or deductibles. HR 6201, or the Families First Coronavirus Response Act, allows for all uninsured individuals to get a free COVID test as well.
Q: If my DPC practice has the capacity to see patients in a telehealth model, what do I need to do to get started?
A: The DPC Steering Committee has been in contact with our friends at Hint to work out these details. In addition, we’ve been approached by dozens of telehealth companies who have requested the help of DPC doctors. Essentially, they want you to take patients and consult with them and, in many cases, they’re willing to pay $20-30 per telemedicine visit. However, even though COVID-19 telehealth visits fall under the urgent/emergency visit protocol and restrictions have been waived, many telemedicine companies still won’t send patients to DPC physicians who have opted out of Medicare. We’re trying to work through that with those companies and we should have answers shortly.
In the meantime, since restrictions have been removed during the current crisis, you should be able to do telemedicine consultations for any COVID-19-related issue. Be in touch with us firstname.lastname@example.org or contact Hint to get more information.
If you have the capacity to take on telehealth patients, please make us aware. Go to hint.com/virtualcare to be listed on a directory of DPC practices that have the bandwidth to take more patients.
Q: If I have my own telehealth service for my DPC patients, can I enroll new primary care patients under telehealth until this crisis settles?
A: There’s nothing that says that you can’t offer a telehealth benefit through an HDHP. However, you can’t offer it to an individual and have the individual pay through his or her HSA. The legislation states that a company can pay a telehealth provider (and under these circumstances, your DPC would fall under this category) a PMPM fee on behalf of an employee without the employee becoming ineligible for contributing toward their HSA.
Q: Is the DPC physician legally responsible to advise patients not to use their HSA card for membership monthly payments? If so, to what extent are DPC physicians liable for any HSA misuse from patients?
A: The onus of HSA enforcement lies solely on the IRS. This means that DPC doctors have no liability if a patient misuses his or her HSA card and that the sanction would be against the patient, not the practice, if misuse occured.
Q: What forms or coding must DPC doctors complete with regards to COVID-19-related telehealth or video-based patient encounters?
A: Since these telehealth visits will be FFS transactions, you must follow FFS coding protocol. To learn more about coding for these telehealth visits, click here: https://www.dpcare.org/covid-19-resources.
Q: If my DPC practice has opted in for Medicare, are we able to see Medicare patients via telehealth?
A: Yes. Virtually every barrier has been waived for the duration of this public health emergency. Go to the CMS website to view the list of Telehealth Services that are covered during this crisis: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.
Q: If my DPC practice has opted out of Medicare, and a Medicare patient needs Telehealth for a non-emergency visit, am I legally allowed to see him or her via telehealth without a DPC membership?
A: That’s unclear right now. We are seeking guidance from the Administration and asking that ALL opt-out restrictions be waived. However, if you are seeing the Medicare patient for emergency care, there is already a blanket waiver in place that will allow you to do so.
Q: Does this new legislation allow me to enroll Medicare patients into DPC membership if my practice is opted in?
A: This is unclear. To understand the ins and outs of enrolling Medicare patients, you would need to speak to your DPC attorney.
Q: Where can I find updates about COVID-19 as it relates to my Direct Primary Care practice?
A: We’ll be posting updates on our website and sending out information through our mailing list. I would encourage you to join the DPC coalition to stay up to date. You can also access our COVID-19 Resource Page by clicking here.