Direct Primary Care Law in South Carolina a Win for Patients and Physicians

By J. Shane Purcell, MD, Direct Access MD, Anderson 

Have you seen the news about primary care physicians?

First, the good news. Communities with a higher number of primary care physicians (family medicine, pediatrics, general internal medicine) are healthier and people in those communities live longer. Having a primary care physician really makes a difference in your health. Now the bad news. Due to lower pay, excess medical school debt, and massive administrative burdens, there is a substantial shortage of primary care physicians. 

Many are retiring early, cutting hours, or leaving medicine altogether. Meanwhile, due to the aging population and the shortage of physicians, the demand for care is sky-high. It’s a perfect storm making access to physicians very difficult. The truth is in our current healthcare system, the is zero incentive for our best and brightest students to consider primary care medicine.

While there are many suggestions being discussed on how to remedy this shortage—economic incentives for primary care training, medical school debt forgiveness, and adding more primary care residencies among other ideas—there is one grassroots movement that is growing over the last two decades that has great potential to slow the shortage and even increase the interest in primary care. It’s called direct primary care (DPC) and it’s grown dramatically over the last decade in every state in America.  DPC is a return of old fashion, patient-centered medical care that gives back control to patients, allowing more time and access to their physician. How is that possible?

Simple. DPC removes the oppressive “middlemen” from the exam room—insurance plan executives, hospital administrators, and government bureaucrats. Primary care physicians working in the DPC model of care cut out all connections with insurance plans and government programs like Medicare. That’s right, DPC physicians do not accept any form of insurance in their offices. They contract directly with patients or their employers for payments using a monthly membership. 

This monthly membership which averages about $79 across America provides all the access the patient needs: in-person, phone, or text visits with no co-pays, email access, after-hours access with the physician, same-day/next-day visits for acute care, extended visit time, access to discounted labs and in some clinics in-house discounted generic medicines.

In DPC, a patient can see their physicians as much as needed, and this keeps patients from going to urgent care clinics or emergency rooms due to poor access to their physicians. Patients have direct access to their own primary care physician on speed dial. A huge win for patients.

At the same time, physicians win too. They get to spend more time helping patients and less time dealing with the administrative burdens of traditional practices like paperwork, computer busywork, and wasted time dealing with insurance plans. Cutting out insurance and government plans allows less overhead and a smaller patient load, usually around 400 to 600 (some family physicians in traditional medical clinics have 2,000 or 3,000 patients or more). So, less overhead costs, less time on computers, more time for patients, and fewer “middlemen” distractions are all wins for physicians. We got wins all around—physicians and patients.

OK, so how does this help the shortage and grow primary care?

Direct Primary Care allows primary care physicians to fulfill their original oaths and work for patients again, not insurance companies or hospital administrators. DPC allows physicians to advocate for patients for the best, most cost-effective care. There is great freedom and reward in this model of care for physicians (and for patients too). 

Allowing more medical students and frustrated, burned-out physicians to learn about the possibilities of this model of care is the key. Making DPC a viable option for physicians to easily start and succeed across America without the need for insurance and government contracts, excessive paperwork, or wasted time on computers is very promising. Transitioning to the DPC model from traditional models of care has saved many physicians. For once there is hope for primary care.

To that end, Representative Anne Thayer (District 9 in Anderson) introduced House Bill 4157 to define Direct Primary Care in South Carolina and to clarify that DPC is not a form of insurance. It’s a simple one-page bill that clarifies the purpose of DPC and keeps the insurance commissioner from shutting down clinics for violating insurance statutes. There are over 30 states in the union that have similar laws and currently South Carolina is the only state in the south without a DPC law on the books. This same law passed the House last session 100-0 before it was killed in the SC Senate.

This bill is a giant step to allow physicians the safety to open DPC practices in South Carolina without facing attacks from the insurance commissioner's office or hiring expensive lawyers to clarify legal concerns about opening in South Carolina. It gives patients more choices in seeking independent primary care on their own terms without the need for insurance. It protects direct contracting between physicians and patients--another option for patients and physicians to connect in a new model of care. 

Again, it’s a win all around.