Hawaii Says ‘Aloha’ to Direct Primary Care

Published July 15, 2016

Consumer Power Report #512

A husband-and-wife team of doctors is turning its slice of Hawaii’s health care system into a luau.

The strategy: Pool their knowledge of two schools of patient care and offer patients membership in the state’s first direct primary care (DPC) practice.

Dr. Michelle Suber is a naturopathic physician, professional dance instructor, and mother of daughters aged 7 and 3, West Hawaii Today reported in June. Suber also founded a middle school that “cultivates the relationship between students and the land through growing and sharing nourishing food in our outdoor living classroom,” with the aim of “connecting land stewardship, culture, health and pleasure with lifelong learning,” according to the school’s website.

Now Suber is combining stewardship and health in a way Hawaii patients have never seen. As of July 1, Suber and her husband, medical doctor Buzz Hollander, converted their traditional fee-for-service practice into Iris Integrative Health, Hawaii’s first DPC practice.

DPC providers offer patients a buffet of preventive care services in exchange for a monthly membership fee, which at Iris starts at $125 for one adult and $50 for one child, with discounts for every family member added. Iris’ fee covers “virtually all the costs of your primary care,” including blood sugar tests, rapid strep tests, flu testing, electrocardiograms, minor surgeries, and other procedures, the practice’s dues schedule states.

Patients who have experienced sitting an hour in a waiting room to be rewarded with six minutes of face time with their doctor will appreciate another benefit: Office visits and phone calls are included in the monthly fee. This perk boosts the likelihood patients will seek preventive care in order to stay healthy and get healthier. Better yet, it reduces patients’ unnecessary and time-consuming trips to the doctor.

In fact, saving time for their patients and themselves was a prime motivator for Suber and Hollander to adopt the DPC model.

“A conventional doctor has to have on average about 2,500 patients in order to survive,” Hollander told West Hawaii Today. “That’s 20–25 patients or more per day, and under 60 minutes per patient, per year. So it’s no surprise that over half of physicians report being burnt out.”

In contrast to conventional doctors, most DPC providers maintain a practice of just 1,000 patients per year, sometimes giving patients 45 minutes–per visit–of face-to-face care.

In addition to offering patients the health care equivalent of an open-buffet pig roast, DPC could help the state of Hawaii “feed the pig”–i.e., the piggy bank. A study conducted by Qliance, a DPC group headquartered in Seattle, Washington, demonstrated a 20 percent reduction in the health care costs of 15,000 Medicaid patients who were given DPC memberships in 2013 and 2014.

Hawaii’s lawmakers are well aware of the increasing financial burden government-funded health care will place on the state budget. Some are hoping DPC will reduce this burden, if House Concurrent Resolution 157, approved on April 27, is any indicator.

More than “338,000 individuals were enrolled in the State’s Medicaid program and Children’s Health Insurance Program,” as of December 2015, and the share of the population aged 60 or older will grow from 18.7 percent to 27.4 percent by 2030, the resolution notes.

Unfortunately, in crafting HCR 157, lawmakers struggled to define DPC accurately. The initial version of the legislation confused DPC–priced to serve low- and middle-income earners–with concierge medicine, which costs far more.

Concierge doctors typically charge between $1,500 and $5,000 annually to provide patients 24/7 access, charge patients additionally for services rendered, and bill through insurance.

DPC, by contrast, typically costs between $600 and $1,500 per year, bypasses middle-men insurers, and includes the services Suber and Hollander offer through Iris’ eight plans. The patient-empowering couple distinguishes DPC from concierge in question 2 of 17 on the “Frequently Asked Questions” on its website.

“… ‘Concierge medicine’ generally describes a very small patient panel and a very high price: upwards of several thousand dollars a year,” the page states. “Our goal is not to fly to Europe with you to meet with your German orthopedic surgeon. We want to provide in-depth, timely, individualized care for a moderate number of patients–small enough to know everyone well, but large enough to care for a sizable hunk of our community.”

Lawmakers ultimately improved upon the House version of HCR 157, but the resolution still instructs the Department of Commerce and Consumer Affairs (DCCA) to study DPC and concierge side by side. DCCA’s insurance division will conduct the study. This is ironic and unsettling, considering skipping insurance altogether enables DPC providers to save everyone money and thus improve quality of care.

Suber and Hollander have taken the DPC plunge. Will others follow? The answer may hinge on lawmakers’ willingness to recognize DPC as the feast amid the government-funded health care famine–a feast to which patients of all income brackets are invited.

— Michael T. Hamilton


Patients in Estero and Fort Myers can now see a doctor without a long wait, co-pay or deductible at the newly opened Gulf Coast Direct Primary Care. As part of the growing Direct Primary Care movement, Gulf Coast Direct Primary Care uses a membership structure to provide more comprehensive care at a lower cost, without the headache of traditional insurance.

Like other DPC practices, Gulf Coast Direct Primary Care will charge patients a monthly fee ranging from $35 to $75 that covers all visits, preventive screenings, and increased physician access such as texts, emails, telephone calls and video conferencing. Labs and more advanced tests and procedures are offered to patients at a discounted rate, and affordable psychology services are available for members.

Although patients are encouraged to keep a low-cost wraparound insurance plan to cover emergency services or surgery, their membership fee would replace a large portion of their monthly insurance premiums, as well as their co-pays and deductibles.

SOURCE: The News-Press (Fort Myers, Cape Coral, Naples, Bonita Springs)

For more than four years, Provision Radiation Therapy has treated patients in the Dowell Springs medical complex off Middlebrook Pike — while various courts considered whether the practice was fulfilling a valid need in the area.

Now the Tennessee Court of Appeals has affirmed Provision’s state-granted certificate of need, overturning a 2014 Davidson County Chancery Court decision that reversed the state’s decision to grant the certificate of need to the center, legally “East Tennessee Radiation Therapy Services” and owned by the nonprofit Provision Trust.

Provision applied for the original certificate of need to install a linear accelerator in August 2011; it was granted in December 2011, and the center began treating patients in August 2012. But health providers Blount Memorial Hospital, University of Tennessee Medical Center, East Tennessee Hospital, Covenant Health and Thompson Cancer Survival Center — all of whom also provide radiation services — opposed the original CON, arguing that 15 existing linear accelerators in the area at the time weren’t even at capacity. …

The radiation center shares a staff of doctors and nurses with the Provision Proton Therapy Center, which opened across the street in 2014. Dowell Springs also has other cancer-related treatment centers on the campus; those patients could then get radiation on the same campus where they’re being treated, Warwick said.

“We believe offering radiation therapy is an important part of our service to the community as a comprehensive cancer treatment center,” he said.

SOURCE: Kristi L. Nelson, Knoxville News Sentinel

Three Republican lawmakers sued the state Department of Public Health and Human Services on Monday, claiming it is withholding information on people enrolled in Medicaid expansion in Montana through the Affordable Care Act and whether participants are qualified.

The lawsuit, filed on behalf of Reps. Tom Burnett and Art Wittich of Bozeman and Sen. Roger Webb of Billings in the 18th judicial district court in Gallatin County, claims that more than 47,000 Montanans have been added to the Medicaid program since November 2015, which they say exceeds projections of 25,000, likely increasing the state’s share of the costs.

They said they submitted a request to the state’s Legislative Fiscal Division on Feb. 9. They sought information on the income and household composition of those who applied for Medicaid since late 2015.

The plaintiffs said they are still awaiting that information after five months. …

SOURCE: Phil Drake, Great Falls Tribune

The “Right to Try” movement may be embedded in the Republican Party platform.

Amid the run up to the Republican National Convention that begins in Cleveland next week, the party has adopted an amendment in its draft platform that endorses a controversial stance toward obtaining treatments for fatal illnesses. Known as Right to Try, the concept is designed to allow desperately sick people to gain access to experimental medicines.

The move embraces so-called Right to Try laws that have been passed by 31 states and allow terminally ill patients to leapfrog the drug development process, which typically takes years before new treatments become available. The platform amendment was introduced on Monday by Eric Brakey, a convention delegate and Maine state senator who last year shepherded such a bill into law in his own state.

“We commend those states that have passed Right to Try legislation, allowing terminally ill patients the right to try investigational medicines not yet approved by the FDA. We urge Congress to pass similar legislation, giving all Americans with terminal illnesses the right to try,” the amendment states, according to Brakey. A final version of the party platform is expected to be completed later Tuesday, he told us.

The laws reflect rising frustration with a Food and Drug Administration program called expanded access, in which people who are seriously ill can obtain a drug under development, even though they are not enrolled in a clinical trial. Under federal law, if terminally ill patients are not eligible to obtain an experimental medicine through a clinical trial, they can apply to the FDA for what is known as compassionate use.

The agency actually approves the vast majority of these requests, which must also be approved by drug makers. But critics say the program is arbitrary and cumbersome. Two months ago, in fact, a bill was introduced in the US Senate as a companion to legislation introduced in the House last year. Neither has progressed, but these are seen by supporters as a key stepping stone toward removing the FDA from the process. …

SOURCE: Ed Silverman, STAT