RICHMOND, Va. (AP) — In January, Dr. Maura McLaughlin started a new type of primary care practice in central Virginia. Instead of getting payments from insurance companies for each appointment, her patients pay her directly, and get unlimited visits for a fixed monthly fee.
McLaughlin has joined a tiny but growing movement of doctors nationally — there are only a handful in Virginia — who have begun to provide subscription-like service to patients, a model known as direct primary care.
Similar to concierge medicine for the rich, direct primary care can appeal to middle and low-income patients who struggle with high deductibles or can't afford insurance at all. McLaughlin charges $60 a month for people over 31, $30 for 30 and under and $15 for kids whose parents are enrolled.
The change from typical primary care has been "wonderful," McLaughlin said: She can focus on fewer patients, spend more time with each one, and worry less about dealing with insurance companies. Other doctors are taking notice, she says, including young ones, who might otherwise avoid going into primary care because of its relatively low profit margins and high-volume demands.
"This can change the trajectory of our whole system," McLaughlin said.
Whether and how this emerging model should be regulated could be the latest sticking point between conservatives and Democratic Gov. Terry McAuliffe over health care policy.
Conservative lawmakers backed by small-business advocates strongly support direct primary care; their legislation clarifies that it is not insurance and cannot be regulated as such.
The legislation sailed through the House this year with bipartisan support, then was almost derailed in the Senate after the insurance industry voiced concerns.
Insurance companies don't oppose the idea of direct primary care in principle, but don't want imperfect legislation rushed through, said Doug Gray, executive director of the Virginia Association of Health Plans. This legislation, he said, is unnecessary and provides no consumer protections.
"There's no problem that needs to be solved," Gray said.
McAuliffe tried to delay the bill's implementation after it passed, but lacked support for his amendment. Now he has until Friday to either sign or veto it. His spokesman, Brian Coy, declined to say how the governor would act.
McLaughlin said she's not trying to compete with insurance companies. She thinks the direct care model can complement traditional insurance. After all, these agreements cover only primary care, not more expensive services such as surgery or hospitalization. McLaughlin said she encourages all her patients to have other insurance to pay for emergencies and other costs.
Getting the legislation passed into law, she said, would help provide legal clarity for doctors as well as small business owners considering providing direct primary care for their employees.
"It just creates an unnecessary level of anxiety about the business model," she said.
If the Democratic governor does veto the legislation, it will be only the latest conflict he's had with Republican lawmakers over health care policy.
The governor has tried in vain for three years to get Republicans to expand Medicaid, arguing it would be a low-cost way of increasing health care access for low-income Virginians. Republicans have said Medicaid expansion is unaffordable, and have been eager to promote alternatives.
The sponsor of the direct primary care legislation, GOP Del. R. Steven Landes, said it boils down to giving customers more choice: "You either want to try and give them that choice or you don't," he said.