Hello all! Brie here! This will be a good way for us to connect for the Rocky Mountain DPC Alliance. Phil, what do you think of the CO DPC legislation coming up?
I’m going to copy what I wrote in the email that went to a couple of you:
I’m concerned about a couple things. One is I think we should be allowed to fire patients or refuse to take patients for the same reasons all other doctors can fire patients. By creating these specific rules, we’re being subjected to more stringent requirements than everyone else. What if a patient no shows repeatedly? Can we chose to not see chronic pain? Etc. As you know, most DPCs care for more complicated patients and it’s the FFS that kicks out people because of their health status. Also COPIC specifically instructs to not give a reason for firing. So how do we handle this? Do we have to give a reason then even though COPIC tells us not to? (In reality, if need be I’ll completely ignore the law and do what I think best but I’d prefer to fix the law and not have to ignore it.)
I also don’t like that we have to contract for a specific time. My patients enter my practice knowing they can leave at any time. It’s entirely month to month. There is no specific end point. Most patients will stay DPC for years until their situation changes and then they suddenly want to leave and that’s fine. I’m not sure why they have that about a certain amount of time but I think it harms patients and doctors.
Otherwise, I’m really happy this is being dealt with finally… I’ve operated in a grey zone for years and would not hesitate to continue to do so but it’s nice to move forward a little.
And here’s the full text of the bill:
1 Be it enacted by the General Assembly of the State of Colorado:
2 SECTION 1. In Colorado Revised Statutes, add 10-16-145 as
4 10-16-145. Direct primary care agreements - not subject to
5 regulation by division of insurance - definitions. (1) AS USED IN THIS
7 (a) “DIRECT PRIMARY CARE AGREEMENT” MEANS A CONTRACT
8 BETWEEN A DIRECT PRIMARY HEALTH CARE PROVIDER AND AN INDIVIDUAL
9 PATIENT OR HIS OR HER LEGAL REPRESENTATIVE IN WHICH THE HEALTH
10 CARE PROVIDER AGREES TO PROVIDE PRIMARY CARE SERVICES TO THE
11 INDIVIDUAL PATIENT FOR AN AGREED-UPON PERIODIC FEE AND PERIOD OF
12 TIME. THE AGREEMENT DESCRIBES THE PRIMARY CARE SERVICES TO BE
13 PROVIDED, THE AMOUNT OF THE FEE THAT MAY BE PAID BY A THIRD
14 PARTY, AND THE PERIOD OF TIME OF THE AGREEMENT.
15 (b) “DIRECT PRIMARY HEALTH CARE PROVIDER” MEANS AN
16 INDIVIDUAL OR LEGAL ENTITY THAT IS LICENSED, REGISTERED, OR
17 OTHERWISE AUTHORIZED TO PROVIDE PRIMARY CARE SERVICES IN THIS
18 STATE AND WHO CHOOSES TO ENTER INTO A DIRECT PRIMARY CARE
19 AGREEMENT. “DIRECT PRIMARY HEALTH CARE PROVIDER” INCLUDES AN
20 INDIVIDUAL PRIMARY HEALTH CARE PROVIDER, PROFESSIONAL
21 CORPORATION, PROVIDER NETWORK, OR OTHER LEGAL ENTITY.
22 © “PRIMARY CARE SERVICE” MEANS, BUT IS NOT LIMITED TO, THE
23 SCREENING, ASSESSMENT, DIAGNOSIS, AND TREATMENT OF THE PATIENT
1 FOR THE PURPOSE OF PROMOTING HEALTH OR THE DETECTION AND
2 MANAGEMENT OF DISEASE OR INJURY WITHIN THE COMPETENCY AND
3 TRAINING OF THE DIRECT PRIMARY HEALTH CARE PROVIDER.
4 (2) A DIRECT PRIMARY CARE AGREEMENT IS NOT INSURANCE AND
5 IS NOT SUBJECT TO REGULATION BY THE DIVISION OF INSURANCE.
6 OFFERING OR ENTERING INTO A DIRECT PRIMARY CARE AGREEMENT IS NOT
7 THE BUSINESS OF INSURANCE OR THE PRACTICE OF INSURANCE
9 (3) A DIRECT PRIMARY HEALTH CARE PROVIDER OR AGENT OF THE
10 HEALTH CARE PROVIDER IS NOT REQUIRED TO OBTAIN A CERTIFICATE OF
11 AUTHORITY OR LICENSE TO MARKET, SELL, OR OFFER TO SELL A DIRECT
12 PRIMARY CARE AGREEMENT PURSUANT TO THIS SECTION.
13 (4) A DIRECT PRIMARY HEALTH CARE PROVIDER MAY NOT DECLINE
14 TO ENTER INTO A DIRECT PRIMARY CARE AGREEMENT WITH A PATIENT, OR
15 TO DISCONTINUE AN EXISTING PATIENT, BECAUSE OF THE PATIENT’S HEATH
16 STATUS. A DIRECT PRIMARY HEALTH CARE PROVIDER MAY DECLINE TO
17 ACCEPT A NEW PATIENT IF THE PRACTICE HAS REACHED ITS MAXIMUM
18 CAPACITY OR THE PATIENT’S MEDICAL CONDITION IS SUCH THAT THE
19 PROVIDER IS UNABLE TO PROVIDE THE APPROPRIATE LEVEL AND TYPE OF
20 PRIMARY CARE SERVICES THAT THE PATIENT REQUIRES. SO LONG AS THE
21 DIRECT PRIMARY HEALTH CARE PROVIDER PROVIDES NOTICE TO THE
22 PATIENT AND AN OPPORTUNITY FOR THE PATIENT TO OBTAIN CARE FROM
23 ANOTHER DIRECT PRIMARY HEALTH CARE PROVIDER, THE DIRECT PRIMARY
24 HEALTH CARE PROVIDER MAY DISCONTINUE CARE FOR THE PATIENT IF:
25 (a) THE PATIENT FAILS TO PAY THE PERIODIC FEE;
26 (b) THE PATIENT HAS COMMITTED FRAUD OR MISREPRESENTATION
27 IN CONNECTION WITH THE DIRECT PRIMARY CARE AGREEMENT;
1 © THE PATIENT REPEATEDLY FAILS TO ADHERE TO THE
2 RECOMMENDED TREATMENT PLAN; OR
3 (d) THE DIRECT PRIMARY HEALTH CARE PROVIDER DISCONTINUES
4 OPERATION AS A DIRECT PRIMARY HEALTH CARE PROVIDER.
5 SECTION 2. Act subject to petition - effective date. This act
6 takes effect at 12:01 a.m. on the day following the expiration of the
7 ninety-day period after final adjournment of the general assembly (August
8 9, 2017, if adjournment sine die is on May 10, 2017); except that, if a
9 referendum petition is filed pursuant to section 1 (3) of article V of the
10 state constitution against this act or an item, section, or part of this act
11 within such period, then the act, item, section, or part will not take effect
12 unless approved by the people at the general election to be held in
13 November 2018 and, in such case, will take effect on the date of the
14 official declaration of the vote thereon by the governor.
When addressing someone specific, make sure to put an “@” in front of their name so they get a notification. For example @Brieseefeldt
@Robin_Dickinson totally agree with you. Discharging patients should not be any different for us.
@Brieseefeldt I replied to you but didn’t know to tell you so you’ll have to log in to read it…but it’s what was already in the email plus the full text of the bill. Thanks @lisainden for telling me about the @ thing.
UPDATE ON CO LEGISLATION:
Passed through the House and we are now waiting for it to go through Senate. It has bipartisan support in the Senate, so fingers crossed!
Passed Senate committee unanimously and first read in committee of the whole. We’re almost there!
Jamie (who I can’t seem to find on here) was asking about the legislation. Anyone know where we’re at now?
Great news from Colorado: We just got word CO HB17-1115, the DPC Bill will be signed by Governor Hickenlooper next week! The signing will be in the Governor’s Executive Chamber, April 24th at 3:05pm. Everyone is invited to attend and celebrate! @philsq feel free to update Frontier.
I’ll be there! @rocky_mountain_group everyone who is coming should wear their stethoscopes so we “look like” doctors!
I wouldn’t miss this historic moment in CO DPC history–c u there!
Look forward to speaking to you then Clint
Would anyone give me the cliff notes on what this bill offers us?
@Kevin_Miller It’s actually an easy read. Here’s the link: https://leg.colorado.gov/sites/default/files/documents/2017A/bills/2017A_1115_signed.pdf
Basically DPC is now defined clearly as NOT insurance therefore not subject to any insurance regulations. We also put in that practices are not subject to additional licensing (some states make DPC docs obtain a “DPC license” in order to practice, which is total BS in my opinion.
Thanks immensely for the pdf…great info.