Research & Commentary: Direct Primary Care Would Ease Georgia’s Doc Shortage

Published August 29, 2018

Like many states, Georgia faces a severe shortage of primary care physicians (PCP). To maintain the Peach State’s primary care utilization rate, Georgia will need “2,099 primary care physicians by 2030, a 38% increase compared to the state’s current (as of 2010) 5,496 PCP workforce,” the Robert Graham Center estimates. Further, The Atlanta Journal-Constitution recently reported 64 of 159 counties in Georgia have no pediatricians; 79 have no obstetricians/gynecologists; and nine have no practicing doctors.

Direct primary care (DPC), also known as “retainer medicine,” is an increasingly popular health care provider model that could revitalize the U.S. primary health care system. Currently, primary care doctors face myriad regulations, a slow and costly reimbursement system, and overhead that can engulf 60 percent of a typical primary care practice’s revenue. According to the Direct Primary Care Frontier, the number of DPC practices has increased from only a few in the early 2000s to nearly 900 as of August 2018.

Several efforts have been made to increase DPC access in Georgia, including a 2018 proposal that would have ensured direct primary care agreements are not considered a form of insurance under the state’s laws. This change would have increased DPC access and lifted the requirements and regulations doctors and patients face under the state insurance code. The bill would have also exempted DPC providers from another major obstacle to health care development: Georgia’s certificate of need program. Unfortunately, the bill did not pass out of the Georgia House of Representatives.

Under a DPC agreement, patients pay a monthly membership fee, typically between $50 and $80. As part of the membership, patients can receive more appointments than they do under a traditional health insurance plan. Some DPC agreements even include same-day appointments and house calls. The DPC model removes the layers of regulation and bureaucracy created by the traditional insurance system and allows physicians to spend more time with patients.

Routine tests and procedures are included in most DPC plans, and lower membership fees are typically charged for programs that do not provide these additional services. Under a DPC model, medical practice overhead can be reduced by as much as 40 percent annually, according to the Docs4Patient Care Foundation. DPC reduces costs across the board. A study in The American Journal of Managed Care found that DPC patients are 52 percent less likely to use services at an expensive hospital than at a traditional private practice. The authors found “increased physician interaction is the reason for the lower hospital utilization and ultimately lower healthcare costs.”

Georgia legislators should follow Nebraska’s lead and implement a DPC pilot program for state employees. The Cornhusker State’s recently approved pilot program will run through 2022 and offer two DPC plans: a high-deductible option and a low-deductible option. Furthermore, the program will include wellness incentives. A similar program in Georgia could demonstrate if additional expansion should be considered.

DPC agreements empower patients to choose the health care model that best suits their unique needs and circumstances. Georgia should remove unnecessary regulatory barriers to DPC, thereby revitalizing the state’s shrinking primary care system.

The following documents examine direct primary care in greater detail.

Policy Diagnosis: Seize the Moment to Reform State Health Care Laws  
In this interview, Michael Hamilton asked Dr. Hal Scherz, board secretary for the Docs4PatientCare Foundation, how the Trump administration is changing the health care regulatory environment and what actions lawmakers should take to improve health care.

Don’t Wait for Congress to Fix Health Care…/dont-wait-for-congress-to-fix-health-care
Heartland Institute Senior Policy Analyst Matthew Glans documents the failure of Medicaid to deliver quality care to the nation’s poor and disabled even as it drives health care spending to unsustainable heights. Glans argues states can follow the successful examples of Florida and Rhode Island to reform their Medicaid programs, or submit even more ambitious requests for waivers to the Department of Health and Human Services, a suggestion the Trump administration has encouraged.

Research & Commentary: Ten Health Care Reform Options for States–commentary-10-health-care-reform-options-for-states  
Heartland Institute Senior Policy Analyst Matthew Glans outlines 10 steps state legislators should take to improve the cost and availability of health care in their states.

Direct Primary Care: An Innovative Alternative to Conventional Health Insurance
Insurance-based primary care has grown increasingly complex, inefficient, and restrictive, driving frustrated physicians and patients to seek alternatives. Direct primary care is a rapidly growing form of health care which alleviates such frustrations and offers increased access and improved care at an affordable cost. State and federal policymakers can improve access to direct primary care by removing prohibitive laws and enacting laws encouraging this innovative model to flourish. As restrictions are lifted and awareness expands, direct primary care will likely continue to proliferate as a valuable and viable component of the health care system.

Restoring the Doctor-Patient Relationship: How Entrepreneurship Is Revolutionizing Health Care in Maine
Liam Sigaud of the Maine Heritage Policy Center analyzes the current direct primary care (DPC) landscape in Maine, evaluates how DPC is benefiting patients, highlights some of the challenges DPC practices face, and offers policy recommendations to promote this type of practice in the future.

Where Obamacare Leaves Questions, Direct Primary Care May Offer Answers
Proponents of the Affordable Care Act (ACA) set out to remake American health care in 2010, but in many respects the ACA didn’t change the health care paradigm at all; it simply doubled down on a broken, decades-old status quo making health insurance “coverage” a national priority, rather than focusing on limiting health care costs and enhancing health care access. Patrick Ishmael of the Show-Me Institute explores in this essay a promising medical practice model, direct primary care, which he says could deliver on the promises made by proponents of the ACA to lower costs and improve access to quality health care.

Direct Primary Care: Practice Distribution and Cost Across the Nation
Philip M. Eskew and Kathleen Klink describe the direct primary care (DPC) model; identify DPC practices across the United States; distinguish it from other practice arrangements, such as the “concierge” practice; and evaluate data compiled from existing DPC practices across the United States to determine the cost advantages associated with this model. Eskew and Klink confirmed DPC practices’ lower price points and broad distribution, but data about quality are lacking.

How Direct Primary Care Benefits Patients with Chronic Conditions
Katherine Restrepo of the John Locke Foundation writes for the Georgia Public Policy Foundation about the effect of direct primary care on patients with chronic illnesses. Restrepo found DPC may allow more patients with chronic illnesses access to health care.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database.

If you have any questions about this issue or The Heartland Institute’s website, contact John Nothdurft, The Heartland Institute’s director of government relations, at [email protected] or 312/377-4000.