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Advocating for Private Direct Practice Models


While there are a number of legal challenges, private direct care models are an enticing way for physicians to become less dependent on plan reimbursement requirements.

The American Academy of Private Physicians (AAPP), is the nation's oldest forum and advocate for private direct medicine (concierge, direct primary care, and connected care models). The AAPP recently held its final 2016 conference in San Francisco. The event included physicians, healthcare technology innovators, and prominent guest speakers on the cutting edge of all three private direct medicine models.  What continues to stimulate interest in all three private direct care models? First, concern and confusion about MACRA and ongoing plan reforms. And second, a desire to create practice models better designed to meet the needs of both patients AND physicians. The conference included roundtable sessions and moderated panel discussions that offered participants exposure to AAPP board members for open dialogue, problem-solving methods, and mutual support.  I had the privilege of presenting at this conference on four major topics addressing:  Navigation through the rapidly evolving plan reform schemes with subscription offerings; Medicare participatory versus opted-out models; data privacy essentials; and, general private direct practice compliance under federal and state laws.

Legal presentations revealed plan reforms, while well-intentioned, that present surmountable obstacles to private direct providers less reliant on plan revenue. Participants learned how private direct practices can play a key role with plan reform goals. I believe private direct practices can deliver plan reform goals with more accountability through concentrated care.  Participants also learned how they can achieve this in terms of more economical considerations where financial resources would be judiciously allocated towards early pre-sickness intervention, disease prevention, and healthy lifestyle promotion.  Private direct practice models trigger federal and state law challenges (including Medicare assignment). Legal solutions to these challenges were discussed, with AAPP physician speakers sharing how they successfully personalized their practices into functional and compliant care models With appropriate legal direction, viable options exist for these practices to practice freely while maintaining compliance requirements.

Participants were cautioned about assembly line practice models, boilerplate templates, physician-to-physician form sharing practices, reliance on informal or shallow legal advice from non-industry non-expert counsel, and warned against the trend of dependence on independent precursory internet "research".  I have seen countless examples of healthcare practitioners being subjected to legal vulnerabilities after shallow business and legal "advice" from the web.  I shared several scenarios of seemingly beneficial private direct medical practices, which have the outward appearance of success, but rather are far from the course of the evolving compliance challenges, especially since Medicare continues to reform reimbursement requirements. 

Each private direct practice model all triggers unique legal issues. Specialized legal counsel should be involved with formation projects to balance compliance objectives while weighing practice options. 

Patients and physicians seem to want better connected primary care options. Ongoing plan reforms aim to deliver care reimbursed based on connection, data tracking, and outcomes. But it is unclear whether state systems or federal authorities will be able to design workable reform models. With ACA reform looming, and a low percentage of physicians understanding MACRA, perhaps state and federal legal reforms may consider better enabling and guiding free-market private direct solutions to better allow physicians to personally pioneer the reorganization of their reimbursement model.

About the author: James Eischen is a Partner at Higgs, Fletcher & Mack LLP with nearly 30 years of experience in corporate and healthcare matters. He is a nationally recognized expert in private fee health delivery monetization compliance. Mr. Eischen is involved in numerous organizations, including the San Diego County Bar Association Law & Medicine Section and Attorney-Client Relations Committee, American Academy of Family Physicians, and American Academy of Private Physicians.

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