Thursday, December 06, 2018

DPC & HSA: A Contrarian's View

We're big fans of Health Savings Accounts and, more specifically, of true catastrophic major medical plans, which would be ideally suited for "wrapping around" Direct Primary Care subscriptions. Currently, DPC fees are not eligible for HSA reimbursement, and there are a lot of folks (myself included) who would like to see that corrected.

On the other hand, it turns out that what seems like a simple idea may not, in fact, be such a slam-dunk:

"A quick analysis of this bill by DPC docs was startling. This “simple fix” was suddenly no longer simple, and it wasn’t really a fix at all."

This was in response to new legislation, called the Primary Care Enhancement Act (PCEA), that has been bandied about the hallowed halls of Congress for a little while. Once it finally got through that meat-grinder, what came out was a stripped down, essentially useless bit of fluff without real-world application or benefit:

"DPC agreements could only include services represented by codes for “evaluation and management” office visits (CPT 99211-5). That means that Pap tests, wellness exams, simple in-office testing, strep tests, urinalysis, EKGs or any office-based procedures would need to be excluded."

Ooops. Again, the goal was to make more widely available a model that took obviously non-insurance services (pap smears, physicals, etc) out of the bloated (and unnecessarily expensive) ObamaPlans and put them back where they belonged: with the patient. By then allowing these fees to be run through one's HSA (just like contact lens solution and baby sunscreen) one's net cost is then reduced, making this an even more affordable option.

Alas and alack, it appears that this is not to be:

"The bill fixes the wrong Internal Revenue Code ... it makes DPC an exempted health plan ... [which] creates conflict in the 25 states that passed legislation declaring DPC is not a health."


And that just scratches the surface of what's wrong with this ill-advised effort. Do click through for more gory details.

[Hat Tip: Dr Lee Gross]
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