DPC Alliance - 2019 Member Election Information

DPC Alliance - 2019 Member Election Information

Elections are occurring now! This blog post will provide you with an overview of open positions, the process for nominations and elections and the timeline for participation.

There will be four openings in our Advisory Committee to fill in 2020. 

What is an Advisory Committee Member?  The DPC Alliance has nine Advisory Committee Members. Advisory Committee Members make up the Board of Directors along with the Executive Committee. The Advisory Committee Members serve three year terms, advise and work with the Executive Committee on all major Alliance decisions and head up sub-groups within the Alliance (such as the Membership Committee, Social Media Committee, etc.). Advisory Committee Members may be re-elected indefinitely and have no limits on number of terms served. At minimum, Advisory Committee Members must participate in a 2-3 hour quarterly call with the entire Board of Directors.

DPC Alliance Member Statement on HR3708

DPC Alliance Member Statement on HR3708

This is a quick member update regarding one of the ongoing lobbying efforts to change the Internal Revenue Code of 1986 (“US Code”) to clarify the use of HSAs for DPC fees.

In preparing an update regarding HR3708, the DPC Alliance Board found itself split, both in our interpretation of the bill and in determining the appropriate response to best represent the interests of our members. Given the value our community places on transparency, and to resolve our internal impasse, the Board decided to share our disparate positions, as each reflects the varied opinions of our membership. Our Vice President-Elect, Dr. Vance Lassey offered that our DPC tribe is uniquely able to disagree agreeably and keep this movement growing forward. 

Background

The Primary Care Enhancement Act of 2019 (HR3708) was introduced to the House Committee on Ways and Means on July 11, 2019. This is a bipartisan bill that was co-sponsored by 2 Democratic and 2 Republican members of the House. The stated objective of this prospective legislation is: “To amend the Internal Revenue Code of 1986 to allow individuals with direct primary care service arrangements to remain eligible individuals for purposes of health savings accounts, and for other purposes.” 

Under the current regulatory environment, patients cannot use HSA dollars to pay for the periodic membership fees of DPC practices. This is why HR3708, and other efforts to change the US Code, are a primary focus of the DPC movement. 

New: Career Opportunities on DPCA Directory!

We’ve recently added a new feature, Career Opportunities, to the DPCA Physician Directory. This will allow Alliance members to share that they are looking to hire (or find a partner) for their DPC practice. This function will be full integrated into management of your practice profile. So, you will be able to add/edit/remove any job openings on your own!

For the public viewing, people will be able to search for these opportunities by map, including narrowing it down by state or proximity to zip code. The Alliance is also forming some partnerships in the broader primary care community so that we can share these opportunities with physicians and residents. Stay tuned for that!

Here is a video walkthrough of how to set up a Career Opportunity on your profile:

Response to opinion in Annals of Internal Medicine

The DPC Alliance, the leading body of physicians practicing in a Direct Primary Care setting, recognizes that there is significant confusion and misinformation regarding the impact that the DPC model is having in health care delivery transformation. This was again demonstrated recently in an Annals of Internal Medicine’s “Fresh Look” blog post by Dr. Brian Block.

Screen+Shot+2019-05-29+at+2.04.47+PM.jpg

Dr. Block’s opinion drew upon dated information and unsupported personal impressions instead of the realities of the growing DPC movement. For example, the study referenced by Dr. Block (and others before him) to characterize the DPC model as unintentionally discriminatory and prohibiting patient access was published in 2005 (before the DPC model even existed!). Also, that study comprised entirely of “concierge” (self-identified) practices which is not Direct Primary Care as it’s widely defined and practiced.

The reality is that hundreds of DPC physicians report their patient populations are not the “healthy & wealthy” suspected by Dr. Block; far from it. We recognize these anecdotes are not a substitute for objective data, but much better than conjecture from people who have zero data and personal experience with DPC practices. To help get more objective information about DPC patients, the DPC Alliance is working with academic researchers to put together a survey of patient demographics and health status… stay tuned for that.

With respect to the new Medicare payment program… In 2018, the Alliance issued comment on the initial “Request for Information” for a potential Medicare “direct provider contracting” project. Our perspective on Medicare’s role in supporting patients in choosing Direct Primary Care has not changed.

For a more real-world impression of what DPC looks like in the trenches please check Dr. Rob Lamberts’ (Internal medicine/Pediatrics physician and DPC pioneer) experience:

Comments from Dr. Rob Lamberts of Martinez, GA:

Let me comment as a fellow internist and having practice in a traditional fee-for-service for 18 years, then a DPC practice for the past 6.

First, it’s a false assumption that it’s either 1000-3000 patients or downsizing to 500-900.  I was in fairly significant burn-out when I left my practice in 2012, and would likely have found an alternative situation to my fee-for-service practice.  There was NO WAY I could practice in an environment that forced me to give substandard care and terrible customer service to my patients.  The current system seems to select against doctors who are patient-centered, and my practice was diving into a money-over-patient mentality that I could not tolerate, so I left.  DPC saved me, allowing me to give high-quality care to 800 patients. I do not believe I was giving anywhere near my current quality of care to any of my 2000+ patients in my old practice.  Is it truly better to give substandard care to a higher number than it is to give excellent care to less?  I don’t think so.  Additionally, we are adding 4 new DPC providers in our area, ALL of whom are coming from either an urgent care or hospitalist setting.  They are leaving because of the ability in DPC to give care like we always wanted to give and they feel abused in urgent care where they see 50+ patients per day. There are lots of providers like them who are coming back to real primary care from outside of that system and bucking the trend away from primary care, instead adding to the providers available to patients.

Second, the policy statement cited was from 4 years ago (2015), a time when DPC was much smaller and less developed than it currently is (it has roughly doubled in that time).  The development of tools to extend the reach of DPC (as it, as you say, is a model that favors innovators) and the movement itself has organized to improve itself, forming bodies like the DPC Alliance and others.

Third, the population of my practice includes approximately 20% Medicare (I am med/peds) and has a significantly lower median income than my old practice.  I am caring for uninsured and many who are disenfranchised by the money-centered care that dominates our system.  I also have about 10% Medicaid patients in my population.  My practice is far more diverse, far less WASP than my old suburban FFS practice.

So, is there any chance DPC doctors will embrace these Medicare proposals?  Why? Would a freed prisoner want to go back to the jail because they got some nicer furniture? My life is better.  My care is MUCH better.  My patients are happier.  I am caring for more of the poor than I ever did in my money-centered practice.  Business are beginning to bang on my door because of the benefit we can be to their employees.  We are beginning to engage some larger businesses, pairing DPC with level-funded self-insured plans that will save them large amounts of money while improving care for their employees and decreasing absenteeism.  Is this pie-in-the sky?  It is being done all over the country now (perhaps not in 2015, though).

DPC is an innovation.  It is not perfect, and there are ways it can be improved to increase its outreach.  But it is a breath of life into primary care which was dying under the obscene burden put on it by blind government agencies and money-hungry insurance companies.  I am baffled by ACP’s continued tepid approach to the first good news primary care doctors have gotten in a VERY long time.

We hope this information clears up any confusion for Dr. Block. But, if questions remain, the Alliance has hundreds of physician-members around the nation who are happy to provide an actual fresh look at innovative primary care.

Joe Grundy
Executive Director, DPC Alliance

Introducing our Executive Director

I am pleased to announce that the DPC Alliance now has an Executive Director! Mr. Joe Grundy will help lead us into the future.

Joe Grundy, MBA   Executive Director, DPC Alliance

Joe Grundy, MBA
Executive Director, DPC Alliance

With a strong background in primary care transformation and advocacy, Joe was one of the very first proponents of the DPC model. While working for the American Academy of Family Physicians, Joe took an interest in the emerging group of rebel doctors doing this “DPC thing.” After deciding we were only half-crazy, he quickly became a believer in our mission and goals. From 2012-2015 he worked on all things DPC within the AAFP, including convening leaders, developing resources, and planning workshops.

In 2015, Joe was instrumental in pushing for and planning the first national DPC Summit in Kansas City. At that time, there were (at most) a couple of hundred active DPC practices in the country. Most of them had just opened recently. Joe and the handful of DPC doctors on the planning committee had no idea what to expect.

We were stunned that 317 doctors from 45 states attended that event. The Summit was a smashing success. The passion was palpable. Dozens of DPC doctors have since told me that the presentations and camaraderie of that weekend inspired them to take their leap of faith.  There have been many seminal moments in the DPC movement, but that conference was a significant spark that helped light this fire. I cannot thank Joe enough for believing in us during those early days.

Since then, Joe has held a few other positions in the primary care world but has always been a champion of the DPC model. We are very excited that he will officially be flying the DPC flag again!

The Alliance already has an excellent start on meany teams, resources, and services. But advancing those with only volunteer physicians has proven challenging. (Some would say, “like herding cats,” but I think it’s more akin to wrestling rabid cheetahs).

Joe will work with the Alliance Board of Directors to fulfill the organization’s mission of providing vision, leadership, and guidance to the DPC community through physician-led education, mentorship, advocacy, and organizational intelligence.

He is the perfect person to help us accomplish our goals and will be a fantastic ambassador.

Welcome, Joe!

W. Ryan Neuhofel, DO, MPH
President, DPC Alliance

Member spotlight: Allison Edwards, MD

IMG_0148.jpg

Meet Dr. Allison Edwards, DPC Alliance Secretary Extraordinaire and founder of Kansas City Direct Primary Care (KCDPC).

Dr. Allison founded KCDPC in January 2017, after working her tail off doing locums work to save money and plan her DPC clinic. She was inspired by other DPC physicians in her home state of Kansas and by her own vision for ideal medical care. Dr. Allison believes, DPC is “medicine the way medicine should be done. It's more time with your patients, and having the time to both get to know them and to make plans that fit in the greater context of their life.”

With her colleagues in the Midwest DPC Alliance, Dr. Allison and KCDPC along with 14 other doctor-owned micro practices purchased and waived over 1.4 MILLION DOLLARS (yes, MILLION!) in medical debt. Learn more about that amazing work here:  http://www.midwestdpcalliance.org/debt-relief-pr

Dr. Allison may not admit it, but she is a DPC prodigy. To launch out on her own cash-practice straight out of residency, to grow in great leadership in DPC circles and mentoring roles all while working locums tenens to financially support her practice AND to do all this in under two years--- amazing.

We salute you, Dr. Allison Edwards. Thanks for showing the great work that can be done when one energetic, capable, intelligent, forward-thinking physician believes, “We can do better.”

For physicians thinking about DPC, Dr. Allison recommends:  “many DPC docs are entrepreneurs by default.  So step up!  Channel your inner entrepreneur spirit and hold on for the ride!”

Find Dr. Allison and KCDPC here: https://www.kansascitydirectprimarycare.com

Member spotlight: Peter Lehmann, MD

LehmanPeter.jpg

Dr. Peter Lehmann has loved medicine since the day he decided to become a physician. He founded Vintage Direct Primary care in January 2016 in Poulsbo, Washington and opened a second location last summer in Kingston, Washington. Offering “modern care with old-time service”, Dr. Lehmann and his staff of 3 keep things personalized, approachable and affordable.

In addition to enjoying the freedom of being his own boss, Dr. Lehmann states DPC affords him so much more time with patients. “I give much more through care than I could ever give in a fee-for-service environment. I refer people out so much less. The days are still long, but I spend my time differently.”

For physicians wondering about transitioning to DPC, Dr. Lehmann recommends doing a lot of research. “You don’t need to reinvent the wheel”. He recommends joining DPC Facebook groups, going to a DPC meeting such as the AAFP’s DPC Summit or D4PC Nuts and Bolts. He states all of the resources are “out there...you just need to PLAN.  The DPC model is simple. The devil is in the details.” 

“Prepare to work your butt off-- for you!”

Learn more about Vintage Direct Primary Care and Dr. Lehmann here:  https://www.vintagedpc.com

Directory & Visitor Services

We are pleased to announce the DPC Alliance Physician Directory. This resource will allow the public or a fellow doctor to easily find a DPC physician in their area, as well as many other things! A few of the unique features of our directory:

INDIVIDUAL PHYSICIANS

Doctors (active DPCA members) will be listed as individuals, rather than by clinic. Information about the respective doctor's DPC practice is included on the profile but we think showing the diverse faces of the DPC movement will be great; as well as provide more information to patients wanting something particular in a primary care physician.

If multiple physicians exist within a DPC practice, our directory will aggregate them by location on the mapper while still providing an individual profile for each.

SEARCHING BY ZIP OR STATE

The search functions are basic now-- allowing a person to look by zip code (e.g. within 50 miles) or by state (e.g. Texas)-- but we are planning on adding more functions here in the future.

VISITOR SERVICES

DPC Alliance members who are logged into their account will also be able to see "Visitor Services" within a fellow doctor's profile. This allows a doctor to look for potential resources (fellow DPCA member) for a patient when they are traveling and need medical attention. Providing this information does not commit a DPCA member to any particular service, and any such arrangements will be done a voluntary, case-by-case, and practice-to-practice basis.

If you would like to see other features added to our directory, please let us know.

Member spotlight: Amy Walsh, MD

Headshot - Amy Walsh.jpg

As a former collegiate gymnast, Dr. Amy Walsh knows a thing or two about excellence. After 20 years in medical practice, including working as an employed physician with Duke Primary Care in Wake Forest, Dr. Amy noted that healthcare was becoming so impersonal, complex and expensive that she had to find another way.

In 2015, Dr. Amy opened doctor direct, a direct primary care practice in Raleigh, North Carolina. When she is asked why she chose to open her own independent direct primary care practice, Dr. Amy says “Why DPC? The real question should be WHY NOT?... Direct primary care fixes all [of the problems of impersonal care] and actually does just the opposite.”

Dr. Walsh is a role model for healthy living. She has four children, two dogs and a husband she’s known since she was eight years old. She is a Founding Member and the first Treasurer of the DPC Alliance. While Dr. Amy states she has always believed that a doctor’s best partner is the patient, DPC allows her to live that belief.

“I tell people all the time that opening doctor direct was the best career decision of my life. Truth be told, direct primary care saved my career.”

Learn more about Dr. Amy, and her physician partner, Dr. Kwark here: https://www.doctordirectmd.com