How Montana is revolutionizing healthcare — with markets

by Lawrence W. Reed

I love Montana for reasons of that Draw me to the country At least once a year: friends, mountains, wildlife, dry air, fishing, to name a few. Now I have a new reason to love it: health care freedom.

Earlier this year, Governor Greg Gianforte signed a bill promising to expand the health care model known as direct patient care (DPC). Increasingly tired of red tape, paperwork, and intrusive third-party rules – especially since the adoption of Obama CareAn increasing number of doctors are choosing to bypass both the government and insurance companies. Under a DPC arrangement, patients pay physicians directly through a monthly membership fee or for specific services provided.

(Note: In other states, where this delivery model is more limited than it is now in Montana, it is commonly referred to as “direct primary care.”)

The average monthly fee for membership-based DPC practices is well under $100 and typically covers all appointments, services, exams, and online consultations in the office. at July 2021 issue From reason magazine, Dr. Lee Gross of Epiphany Health DPC in Florida notes that “about 85 percent of all health care services in the country can be managed at the primary care level, and that is the largest portion of health care delivery in our country.”

When physicians and patients interact with each other directly, physicians are “able to charge less than traditional practices,” Writes Mark McDaniel, “Because the lack of coding and billing means they don’t need to hire a support team.” The savings are colossal — cutting health care costs, some say, by more than half. at Cost savings for direct primary care patientsKristel Thornton WritesAnd the

Many DPCs also include lab and x-ray services in their base monthly fee and offer discounted rates for prescription drugs and other healthcare services. DPCs do not accept insurance but generally encourage patients to maintain highly deductible and catastrophic insurance… A recent article in Consumer Reports states that DPCs “can be cost-effective and appropriate for people who have chronic Health problems that need close monitoring, such as diabetes, high cholesterol and high blood pressure. “

Furthermore, the typical DPC patient benefits from a closer relationship and more personal time with his or her doctor than with traditional arrangements. (See the articles in Recommended Readings below for more details.)

The biggest obstacle to the DPC model is the threat of red tape and government regulations at the federal and state levels, as well as pressure from those who have a vested interest in the high-cost and less-than-transparent status quo. Montana’s new law removes much of this, and goes further than any other state to date by opening the door for dentists, mental health care providers and other professionals to offer options directly to their patients.

He was one of the heroes of the bill signed by Governor Gianforte Frontier InstituteHeadquartered in Helena. I serve as a member of the institute’s board of directors, so I am particularly proud of the institute’s key pedagogical role in this landmark legislation. Our CEO, Kendall Cotton says, “The Dubai Policy Center (DPC) has proven to be a transparent, low-cost, high-quality option for the care of Montana residents struggling with high medical expenses. This reform makes our state a national leader in affordable healthcare options that exceed Paperwork and bureaucracy put doctors and patients in charge.” (Credit also goes to Montana Senator Carrie Smith, whose long-standing support for these reforms has proven crucial.)

The Frontier Institute is just over a year old, but it has quickly become a model of how a small think tank can make a big difference. A friendly new governor and legislature adopted many of Frontier’s proposals this year. Governor Gianforte says he wants to “make Montana a haven of liberty and free markets” — a goal the institute is well positioned to help achieve.

Between 2017 and 2021, eight new DPCs opened in Montana; This number is now expected to grow significantly under the new legislation. There are signs that doctors may start moving to Montana where they can use the DPC form more freely.

A dermatologist named Dr. Kathleen Brown, a longtime friend of mine on Facebook, is a case in point. (I met her in person at Helena last month.) She’s exactly the kind of medical entrepreneur that Montana’s new law seeks to encourage.

Born in Virginia, Kathleen earned her undergraduate degree at the College of William and Mary, where she majored in biology and music. I completed two residencies and worked at Johns Hopkins University School of Medicine. She, her two daughters, and her husband, Jack, who built several retail businesses, moved to Oregon in 1997, where Kathleen practiced internal medicine and dermatology at a clinic in Coos Bay.

In 2011, Kathleen set out on her own by opening her own clinic, Oregon Coast Dermatology. She chose a three-tier fee schedule instead of membership, but the general concept of her specialist practice was the same – a direct payment relationship between patient and physician without intermediaries or bureaucracy. As she told me in her own words,

I got rid of all third-party payer intrusions and arbitrary pricing so I can more easily customize my practice to what patients need. I had a beautiful facility with a great laser, surgical suite, phototherapy, digital mapping, lab, etc. Medical services are priced based on the time spent with me, (with overhead included), according to a three-tiered fee schedule, depending on the type of service. The fee schedule was posted online and in the lobby.

A lot of people, especially doctors, said it would never work, in part because we were in a not-so-rich area, and people wouldn’t pay. However, within a couple of months, my schedule was completely full, including people without insurance, those with high deductibles, and even many with rich medical benefit plans. Many of these people were not likely to receive any compensation from insurance or government plans when they saw me, but came anyway and paid their money at the end of the visit. If it didn’t suit them, they went somewhere else. In nearly eight years, only five visits have been paid incompletely, and I’ve never had anyone who hasn’t paid anything. I have never used a collection agency. I never mailed any invoices. The total amount paid was short only about $500.

During my first year, I was so busy that I started visiting a clinic once a week, on a first come, first served, to arrive basis. People would come from hours away, often wait their turn for hours, and then say “thank you” to us for having them. As I had a half day each month, my bill was paid at a discounted rate of $10 or $20 to visit people I knew were struggling financially. The patients were great at this practice. He puts everything on a very personal and accountable basis.

Kathleen points out that a membership model is not the only way to do direct care, and that membership models are usually not the best fit for specialist practices like hers. Prefer the term “direct payment” to describe the model you are using.

With third parties (government and insurance companies) out of the picture, running her own clinic was a liberating experience for Kathleen. She could be a full-time doctor without a rig.

However, Montana noted that. She first fell in love with the country in 1977 during a summer job there when she was an 18-year-old college student. While in Oregon after 1997, she found time to visit more often.

Oregon was “a beautiful state with many good people,” she says, but “because of the high state income and property taxes, as well as the generally unfriendly business and political climate, it was time to move on.” In 2019, she closed her clinic and moved with Jack to Treasure State, also known as Big Sky Country. According to the Cato Institute the most recent Freedom in 50 countries In the ranking, Brown left the No. 44-ranked state decisively freer, at No. 16. The Frontier Institute expects this ranking to improve further, in which case I’ll also spend more time there.

Referring to the deregulation that the Frontier Institute has supported, Kathleen tells me, “The recent changes to Montana’s laws look too good to be true!” So while you’re reading this, she and Jack are in the process of starting another dermatology practice in their newly adopted state. Here’s how she describes her plans:

This time, it will be minimized and moved, to take special care of underserved sites. Not only do we want to provide the care needed to fill in the gaps; We want to serve as a model for other professionals. We think this will particularly appeal to those like me who don’t want to be employed or have a full time job, but want to enjoy the amazing state of Montana for the latter part of their career. We believe this will match those who need medical care with those who want to practice medicine as it should be, with high quality and affordable prices in a personalized and personalized way.

If direct-pay models become common — in primary care as well as in the kind of specialized care Kathleen provides — they will empower and liberate both patients and clinicians and do more to reduce costs than any other health care reform. Then the insurance will only deal with the catastrophic expenses, which means the premiums will go down. It sounds like common sense, but there are still a lot of organizational and ideological barriers. People who want bureaucrats in charge of your health care will resist any advances in the direct payment model.

In the reason The interview referred to above, Dr. Lee Gross Hints the potential:

The first time I went to Washington and gave a presentation on direct primary care, I gave it to a group of doctors, and after I gave my presentation about our practice and what we were doing, a doctor raised his hand and said, “You charge $80 a month. What happens if Set up a doctor right next door and charges you $40 a month?” I said, “That’s an excellent question, because if the first question the public asked was, ‘What are we going to do when we lower healthcare prices? “We are on to something…

So if we are looking for an ideal healthcare system, we want to see three pillars. We want to see lower cost, better quality and more options. You can’t have those three in a government-run system. You can only have those in a free market capitalist system.

Good luck with your new clinic in Montana, Kathleen Brown! I have no doubt that you will succeed again and prove that making Montana a “haven of liberty and free markets” is a win-win.

What would free health care to the market actually look like by John Osterhoudt

Doctors choose not to take out insurance by Mark Daniel

How does direct access to primary care work? (Video) by Anthony Davis and James R. Harrigan

The future of healthcare is already here by Austin Schanzenbach

CPT Coding: Medical Practice or Insurance Job? by Lawrence R

More patients are turning to ‘Direct Primary Care’ by Kristen Lyman

Direct primary care: evaluating a new model for delivery and financing By Fritz Bosch, Dustin Grzyskowiak and Eric Huth

How the market actually canceled Obamacare by Stuart Jones

I was a physician at a federally qualified health center. Here’s why I no longer believe government healthcare can work by Rebecca Bernard

Cost savings for direct primary care patients by Kristel Thornton

Frontier Institute’s “Montana Restoration Agenda”


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