Trump’s New Executive Order: Unleashing HSAs For Direct Primary Care

You might have missed this big news because the media .08/04/2019 8:11:46AM EST.
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D is for Distortion: Medicare Part D’s $2 Billion Problem — 46brooklyn Research

Overall, we estimate that of the $1.08 billion in total Part D spend on this drug, only $434 million was for the drug – the remaining $648 million went to the supply chain.



Ing. Cost ($434M)

Markup ($648M)
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I hate it when patients get ripped off

As so many of us are aware, the cost of healthcare, basic primary care, is skyrocketing.  Patients are at the mercy of the industry pricing and they rarely know the cost before deciding to seek care.  Many times the charged price is 10 times as much as the negotiated rate set by insurance companies and 20 times as much as the lab test actually costs to perform.

I joined the Direct Primary Care movement in 2016 to help patients find lower cost options for their healthcare.  TDPC’s parent company, Trinity Medical Associates, has been innovating new ways to lower the cost of care for our community for years.  Direct Primary Care has become a powerful force benefiting patients regardless of insurance coverage.  When we are able to push the price lower everyone benefits.

In our program, we’ve been working with our national lab vendor to seek out lower cost prices.  How has this worked out?  So far we’ve been able to secure 60-90% savings off most all labs and many common labs are now so inexpensive for us to purchase, we provide them for free with membership.

For instance, the standard labs I use to manage diabetes like a Hgb A1c, a lipid panel, a kidney and liver function panel, and an insulin level are all free four times a year.  That’s the normal follow up schedule for diabetes.  These labs are so inexpensive it felt like the right thing to do to give them to patients without cost.  I mean, I don’t charge for checking your blood pressure either.

Recently, one of my colleagues showed me a price list for common labs available to his patients.  Generally, these prices are already at a discount from what is charged by medical practices so retail pricing might be even higher.  I’ve overlaid the prices for my practice for comparison.

Lab price comparison


Well, you can see for yourself the cost differences in what you might pay somewhere else and the savings you’ll get through the Trinity DPC program.  By lowering the cost of labs, patients have better access to primary care services regardless of insurance coverage.  They can monitor and manage their chronic illnesses easier and, maybe, those illnesses become a little less chronic.  Complications of these illness could improve which would lead to less death and disability in the people about whom I care.  How much better would it be to not need dialysis or an amputation?


If you take this price list in total, the cost of all the labs through the Trinity DPC program is only $165.  Through the regular, insurance based system the cost is $2562.74.  Imagine meeting your deductible every year just because of the cost labs.  We can offer patients a  $2397.74 discount, a savings of 93.6%, just by avoiding the price fixing scheme of modern healthcare.  What would you do with an extra $2397.74 in your pocket each year?

-Dr. Mark B McColl













































































































Can’t Afford Health Insurance? Americans Rig Their Own Safety Net – Bloomberg

Consumers frustrated by high costs are bypassing the bureaucracy with patchwork plans.
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I’ll say it again, ‘Health insurance is not the same as healthcare.’

It’s not just the uninsured — it’s also the cost of health care

It’s not just the uninsured — it’s also the cost of health care

We still have an uninsured problem in the U.S., but we have a far broader health care affordability problem that hits sick people especially hard.

Why it matters: It’s time to think more broadly about who’s having trouble paying for the health care they need. The combination of lack of insurance and affordability affects about a quarter of the non-elderly population at any one time, but almost half of people who are sick.

Now that the Affordable Care Act has expanded health coverage, the percentage of the non-elderly population that is uninsured is now just under 11%, the lowest level ever recorded. But as the chart shows:

  • Another 15.5% who have insurance either skipped or delayed care because of the cost or reported that they or someone in their family faced problems paying their bills in 2017.
  • That brings the total percentage of non-elderly people with insurance and affordability problems to 26.2%.

More striking: nearly half of all people in fair or poor health — 46.4% — are uninsured or have affordability problems despite having coverage.

  • That includes 13.5% who were uninsured and in fair or poor health — arguably the worst off in the entire system — and another 32.9% percent who have insurance but said they or a family member have had a problem affording care in the last year.

It’s not surprising that people who are sicker and need more care would have more problems paying for it. But arguably an insurance system should work best for people who need it the most.

All this says a lot about current health care politics.

  • It helps explain why so many people name health their top issue, despite the progress that has been made in covering the uninsured. And everyone who’s sick and can’t afford medical care has family members and friends who see what they are going through, creating a political multiplier effect.
  • It is also why health care is substantially an economic issue as well as an issue of access to care. When people have trouble paying medical bills, it’s a hard hit to their family budgets — causing many people to take a second job, roll up more debt, borrow money, and forego other important family needs.

For as long as I have been in the field, we have used two measures more than any others to gauge the performance of the health system: the number of Americans who are uninsured and the percentage of GDP we spend on health. Both measures remain valid today.

The bottom line: If we want a measure that captures how people perceive the system when the number of uninsured is down and overall health spending has moderated, we need better ways of counting up the much larger share of the population who are having problems affording care.

And whatever big policy idea candidates are selling, from single payer on the left to health care choices on the right, the candidate who connects that idea to the public’s worries about paying their medical bills is the one who will have found the secret sauce.

The tide is changing

As an advocate of free market principles in healthcare, I’ve pushed for clear transparent pricing for all sorts of services.  Naysayers argue that in the time of crisis a patient shouldn’t be asking “How much to treat my heart attack at that hospital?”  I agree.  However, a large amount of healthcare is not delivered during a crisis.  And as non-emergent prices drop, so will other prices.  A bag of saline shouldn’t change price just because it’s given in the ER versus the office setting.

The University of Michigan healthcare site now lists prices for many common office visits, advanced imaging studies, and procedures.  While these prices aren’t really that good, it is a good start.  Prices get better when the seller, in this case the hospital system, has to tell the buyer, in this case a patient wanting healthcare in U of M’s system, because this gives the buyer a chance to say “Are you nutso? I can get that CT scan of the abdomen without contrast for $250 from my DPC physician.  I’m not going to pay $1442.”  That’s how the free market works.

CT U of M

I’d be remiss if I didn’t point out that virtually all of U of M’s preventative visit prices for each age group would cover either all or most of the cost of a year’s worth of membership.  Our pediatric membership is only $348/year which includes the well child visit AND ALL OTHER VISITS FOR ALL OTHER REASONS TOO!   Additionally, U of M’s pricing doesn’t include labs which drives up the cost more.

Preventative Visit pricing at U of M

Seriously, you should check out their prices.  A lipid panel for $135?!  Even with the 40% uninsured discount that’s a rip off.   I can buy a lipid panel for less than $3 which is why I don’t charge for it but include it free with membership.

lipid panel at U of M

So the tide is changing.  U of M has put all other hospitals and major medical centers on notice.  They will be posting their prices too and then we get to compare.  Feel free to compare them to my prices too. 

Is Single Payer the Future of Healthcare?

Here’s a good debate from December 5, 2017 on the subject.

Is single payer the next step in American health care? What alternative approaches can we explore? The Dole Institute Student Advisory Board will examine differing systems and the future of U.S. health care policy with special guests Dr. Joshua Freeman and Dr. Josh Umbehr. Freeman is professor emeritus at KU Medical Center, while Umbehr is a KU School of Medicine graduate and the owner of Atlas MD.

My bias is obvious.

Open Enrollment may indicate a farewell to savings

November 1st marks the start of’s annual open enrollment period.  Here’s an example of what our neighbors who don’t qualify for a subsidy should expect.  For an  average small business owner family (two parents, two school age kids) with no subsidies, they have this to look forward to.

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It is incredibly demoralizing to think that an average small business owner with a family of four might have to pay the equivalent of their mortgage for a plan that doesn’t pay anything until they’ve spent $11,300 out of pocket.  If they actually need care they might be paying even more out of pocket.

We need a better way.  In part, Direct Primary Care offers a better way.  While we can’t change how much insurance costs when the government buys it (although we do vote and that’s something), we can change how expensive high quality primary care is.

As the largest Direct Primary Care program in the area, we are able to offer the lowest cost option for services.  With your monthly membership there is no cost for office visits, no cost for phone calls, no cost for email contact with your physician (seriously, here’s Dr. McColl’s direct patient email:, and no cost for most in-house labs or labs needed to manage diabetes, high blood pressure, or high cholesterol.  We offer a simple, straightforward plan for you to be able to take care of your health needs.  Everything that isn’t covered by membership is priced as low as we can make it and discussed before it is done.  You’ll never be surprised by a bill.  Just check out our Trinity Direct Primary Care Lab Test Pricing Guide to see some of the savings you can expect.

In the coming year we will be adding medication dispensing at wholesale prices, telemedicine specialty consultations to help us manage complex issues without patients having to see as many specialists, and counseling with a nutrition expert at our office.  Stay tuned for those details.

Give us a call to schedule your own personal Meet and Greet or Medical Consult to get to know us better.  When you’re ready to save money on primary care and experience ‘Healthcare without hassles, built for you’ then sign up online.  We’re offering a special coupon to anyone who signs up the first seven days of open enrollment.  We’ll give you one free month of membership in the form of 10% off membership rates for 10 months.  Just follow this sign up link to get the discount.

We’re ready for a change in healthcare, are you?

Employers lower healthcare spending with Onsite Clinics and Direct Primary Care membership

blood pressure cuffTrinity Medical Associates offers two  excellent options for employers seeking to lower their healthcare spending while maintaining a high level of employee care and accountability.

The first choice is a Trinity Onsite Clinic.  We can setup, staff, and operate a full service primary care office within your facility.  With a Trinity provider onsite during the work day employees have ready access to a trusted healthcare profession from their community.  Follow up visits, wellness and nutrition counseling, and preventative health visits can all be obtained with minimal work interruption.  Trinity has become the second largest independent primary care group in the area and are able to provide a great depth of resources which are at the disposal of the onsite clinician.  Lab draws, point of care testing, referrals to specialists, and all typical primary care office services can be arranged through the onsite clinic.  Visits are most often processed on a fee-for-service basis through the employers health benefits plan.  Trinity operates several onsite clinics in the region and has the experience to establish new locations quickly and competently.

Dr.McColl-9768-683x1024The second choice is to provide employees a membership in Trinity Direct Primary Care.  Trinity established their Direct Primary Care (DPC) program in January 2016 and now operates the largest DPC practice in the region with offices in Hardin Valley and Maryville.  DPC focuses on providing members a comprehensive primary care experience through a low cost monthly membership fee.  Members have the freedom to directly contact their DPC physician via phone or email throughout the business day and schedule office visits that are longer in duration and more in depth.  With no per visit fees and most common labs included in the cost of membership, most patients have no extra charges apart from the membership fee.  Labs and services not covered by membership are offered at 60-90% off retail pricing.  Members also have access to discounted rates for advanced imaging such as CTs and MRI which are less expensive than rates provided through insurance plans.  Employers can choose to cost share with employees by having them be responsible for non-membership charges or choose to  reimburse employees for these charges.  This provides employers with a stable, predictable monthly healthcare spending plan.  DPC is especially appealing to employer with self-funded insurance plans.  Trinity DPC has contracted with several area employers who are providing full service primary care to their employees.

If you have questions about which program might be best for your company please contact Leah Parker, Trinity’s Practice Administrator, at 539-0270 or Dr. Mark McColl, managing partner of Trinity Direct Primary Care, at 244-1800.

Here’s a helpful reference article describing some of the differences of Onsite Clinics and Direct Primary Care programs.

What is the difference between an Onsite Clinic and Direct Primary Care? by Tom Valenti

Article: Health Care Is So Expensive Because You Don’t Pay For It Yourself

Health Care Is So Expensive Because You Don’t Pay For It Yourself

I could write a good review of this as it is an excellent read on healthcare economics.  This truly complex topic can be simplified by using a few easy analogies and these four quotes.  I’d highly recommend you read it for yourself though.


Health care is essential to life. But it is far less essential than food or housing, which do not require third-party payment.

What is unique about health care is not fee-for-service, but third-party payment. Only in health care is someone else picking up the tab for our spending.

The problem is third-party payment.


No one will ever reform the U.S. health care system without bringing the consumer along and, indeed, placing consumer choice and accountability at the very center of the reform initiative.