DPC News

WASH. OIC Report, 2020 on DPC

Annual Report to the Legislature

December 1, 2020

Mike Kreidler, Insurance Commissioner | http://www.insurance.wa.gov

State law requires direct practices to submit annual statements to the OIC that include:

+ The number of providers in each practice.

+ The total number of patients.

+ The average direct practice fee.

+ Names of direct practice providers.

+ Business addresses.

The DPC Journal and its sister publication (independent trade publications observing these free market healthcare subscription-based delivery spaces) put together an infographic to help understand and educate both Physicians and Patients about the features and benefits of each program/business model. (C) All Rights Reserved. 2020

The Legislature did not give the OIC specific rulemaking authority over direct practices. However, the OIC has the authority to tell direct practice clinics how to submit the statements, what format to follow in submitting statements and what data to include.

The OIC’s annual report to the Legislature must include:

+ Participation trends.

+ Complaints the OIC has received.

+ Voluntary data reported by direct practices.

+ Any modifications to the chapter the OIC recommends as necessary.

Direct practices originally began filing annual statements with the OIC in October 2007. In September 2020, the OIC sent its annual statement to registered practices. This statement collects the mandatory information state law requires and asks several voluntary questions.

Key Points of Interest

+ The OIC annual re-registration statement asks direct practice clinics if they collect information about patients’ other health plans when patients enroll. In 2020, 36 of the 44 responding direct practices indicated they collect this information. (Read Full Report/Download …)

+ A key assumption underlying the legislation was that direct practices could provide affordable access to primary services. In theory, this would reduce pressure on the health care safety net or relieve problems caused by a shortage of primary care physicians and possibly reduce emergency room use. (Read Full Report/Download …)

+ The average monthly fee decreased from 183.97 dollars in Fiscal Year 2019 to $142 in Fiscal Year 2020. It is to be noted that this is because the new direct practices have a monthly fee of $61.00 and a number of clinics decreased their fees. (Read Full Report/Download …)

+ 33 practices voluntarily reported the percentage of their business that is direct practice. 10 practices reported that less than five percent of their business is direct practice. One practice reported that more than 15 percent and less than 20 percent is direct practice. (Read Full Report/Download …)

Under Washington state law, direct practices cannot bill insurers for primary care services provided under the direct practice agreement because this would result in “double dipping” or collecting payment twice for services provide. Patients are advised to obtain other insurance such as a high-deductible health plan, also called “catastrophic plans,” to ensure that emergency and other services are covered.

Concierge Medicine Today and its annual Conference this year (eg Winter 2020) released an exclusive 3-Part series on DPC, HSAs and an in-depth analysis of how HSAs can and do function with these types of practices.

Other Notable Summaries

Direct practices file a statement with the OIC to register and then annually submit a statement to continue to offer direct practice services. Over the past two years, the OIC has seen an increase in the need to protect consumers from unlawful direct practice agreements during the first filing or initial submission with the OIC. When a direct practice submits its first statement, the OIC reviews direct practice agreements from compliance with Chapter 48.150 RCW, the laws governing direct practices. There has been an increase in improper fees detailed in direct practice contracts, such as cancellation fees and refusing to refund consumers who paid in advance but want to terminate their direct-practice agreement.

More frequently, direct practice agreements fail to include information required by law to fully inform patients. For example, some agreements frequently fail to include a disclaimer statement to inform consumers that a direct practice agreement is not comprehensive coverage. Consumers need to understand that emergency and specialty care must be paid out of pocket or that consumers should purchase a supplemental health plan. RCW 48.150.100 requires direct practice agreements to contain the OIC’s contact information to help consumers, however this is rarely included. It requires an increasing
amount of time for the OIC to conduct its review of direct practice agreements.

(Read Full Report/Download …)

Participation in Fiscal Year 2020

Enrollment decreased at 13 direct practice clinics.

  • The 13 practices that enrolled fewer patients reported a total decrease of 1,408 enrollees.
  • Delta Direct Care – Battleground reported a decrease of 1,172 direct practice enrollees.

18 direct practices voluntarily reported that they participate as in-network providers in a health carrier’s network in 2020. This is a significant change since reporting began in 2007 when all reporting practices performed direct-patient provider primary care exclusively.

Enrollment increased at 24 direct practice clinics.

  • Enrollment increased by 35.20 percent from 14,482 total enrollees in Fiscal Year 2019 to 19,579 enrollees in Fiscal Year 2020.
  • One clinic experienced an enrollment increase of 467 patients: RediMedi Clinic – Wenatchee grew from 712 patients in 2019 to 1,179 patients in 2020, a 39.6% increase. RediMedi Clinic – Wenatchee increased its enrollment by 65.59 percent from 712 patients in Fiscal Year 2019 to 1,179 in Fiscal Year 2020.
  • 20 clinics reported a combined total of 1,475 new patients. Increases in new enrollees range from one at GoodMed Direct Primary Care – Seattle, to 467 at RediMedi Clinic – Wenatchee.


Annual Report to the Legislature

December 1, 2020

Mike Kreidler, Insurance Commissioner | http://www.insurance.wa.gov

READ FULL REPORT; (Read Full Report/Download …)

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