RELATED INTERVIEW | EXCLUSIVE
By Mike Kreidler, Insurance Commissioner, http://www.insurance.wa.gov; December 2018 | For 2018, 20 of the 41 direct practices that responded.
State law requires direct practices to submit annual statements to the OIC by October 1 of each year. The Legislature did not give the OIC rulemaking authority over direct practices. However, the OIC does have the authority to tell direct practice clinics how to submit the statements, what format to follow in submitting statements, and what data to include. Under state law, direct practices cannot bill insurers for primary care services. As a result, if direct practice enrollees have private insurance, it makes sense for them to buy a high-deductible health plan, also called catastrophic plans. There is no practical means for the OIC to monitor direct practices for compliance with Chapter 48.150 RCW. Therefore, the Insurance Commissioner recommends requiring direct practices to answer all of the annual survey questions.
RCW 48.150.020 prohibits discrimination by direct providers. However, the questions that seek information about the possibility of discrimination in practices are voluntary and are most often left blank.
Additionally, RCW 48.150.050 prohibits direct practices from establishing a direct practice agreement with employers, but the questions directed at ascertaining compliance with this provision are voluntary.
Participation trends in fiscal year 2018
- There were approximately 18,268 direct practice patients out of 7.4 million Washington state residents, as reported by the U.S. Census Bureau — representing a grand total of 0.24 percent of the population.
- Overall patient participation increased 23% to 18,268, from the fiscal year 2017 total of 14,790 patients, an increase of 3,478 patients.
- The number of practices registered with the OIC increased from 40 in 2017 to 41 in 2018.
- Based on the direct practices that completed the OIC survey in 2017 and 2018, fees changed in the following ways:
- 16 direct practices did not change their fees.
- Five direct practices decreased fees.
- 11 direct practices increased fees.
- Complaints received: The OIC’s consumer advocacy team did not receive any formal or informal complaints regarding direct patient practices.
- Thirteen direct practices reported Medicaid enrollment:
- Fiscal year 2018: 214patients or 1 percent.
- Fiscal year 2017: 196 patients or 1 percent.
Direct practices have been filing annual statements with the OIC since October 2007. For the 2018 report, the OIC sent the survey to the direct practices in September2017. The survey collects the mandatory information that state law requires and asks several voluntary questions. This report compares data from two fiscal years of annual statements:
- Fiscal year 2017: July 1, 2016– June 30, 2017
- Fiscal year 2018: July 1, 2017– June 30, 2018
- Information for prior years is available on the OIC’s website.
Direct practices and the insurance market
The OIC survey asks direct practices if they collect information about patients’ other health plans when they enroll. For 2018, 20 of the 41 direct practices that responded said they collect this information. According to the 20 practices that responded, the number of direct practice clients who are uninsured are:•Fiscal year 2018:317 enrollees, or 1.7percent.
- Fiscal year 2017: 450 enrollees, or 3 percent. Under state law, direct practices cannot bill insurers for primary care services. As a result, if direct practice patients have private insurance, it makes sense for them to buy a high-deductible health plan,also called a catastrophic plan.The number of direct practice patients who have private insurance (not Medicare or Medicaid):
- Fiscal year 2018:13 direct practices reported 4,375 patients had private insurance, or 23 percent.
- Fiscal year 2017:13 direct practices reported 5,677 patients had private insurance, or 38 percent.