Doctor Seeks More Inclusive Definitions for Medical Care Expenses

7/10/20

CC:PA:LPD:PR (REG-109755-19)
Room 5203
Internal Revenue Service
P.O. Box 7604
Ben Franklin Station
Washington, DC 20044

Re: REG-109755-19 — IRS Proposed Rulemaking: Certain Medical Care Arrangements

Dear Madam or Sir,

I am writing in regards to the IRS proposed rule regarding deductions for medical care arrangements including direct primary care arrangements and health care sharing ministries. I am a physician from Indiana with over 30 years of experience practicing family medicine, and in 2014 I founded PureHealth Functional Family Medicine to provide each of my patients with a customizable treatment plan that gets them from illness to health in the fastest and least expensive way possible. My direct primary care (DPC) practice allows me to provide the highest degree of medical advice possible because I am no longer financially influenced by the standardized protocols affiliated with third-party payment systems, which ensure mediocre care for all.

At the core of my approach to medicine is my belief that in-depth biochemical analysis is the best way to diagnose and treat illnesses, not shallowly-thought out protocols. But for the first part of my career, I found myself spending more and more time doing things that had nothing to do with anatomy and physiology. Employers, insurers, governments, and hospitals each had their own series of standard responses to patients' maladies, but these things minimally improved how the people I was treating felt, and never cured them. As time went on, I realized that prices for everything were getting higher and higher, and my patients (wisely) did not trust the healthcare system to truly care for them. Then I got sick, and I realized first-hand that the answers I got from the healthcare system were not logical, scientific, or complete.

Since starting PureHealth, I have seen a dramatic improvement in the relationships that I have developed with each of my patients and in the level of care they are receiving. My DPC practice allows me to customize each treatment plan: for each patient I work with, I get to evaluate what treatment plan aligns best with their individual financial and moral goals. The DPC arrangement allows me to be an unconflicted servant where I am paid to think as deeply as possible about nothing but each patient's desires for their personal health and finances. This approach to medicine is functional, cost-effective, and allows physicians like me to truly help patients to the best of our abilities. I strongly support the IRS's overall goal of trying to incentivize patients to consider alternatives to traditional, third-party-payment healthcare and appreciate that you acknowledge how productive DPC arrangements can be for patients.

While I support the general tenets of the proposed rule, I believe the current definitions for direct primary care and health care sharing ministries both need to be modified to be more inclusive:

First, the definition of DPC arrangements should be expanded to include care administered by nurse practitioners, clinical nurse specialists, and physician assistants. By classifying an increased number of health care providers as primary care providers for the purposes of the proposed rule, patients will have increased access to and choice of reliable services through DPC arrangements. Including these types of practitioners in the definition will help keep DPC arrangements affordable and also increases the services that clinics and offices can offer to their patients. For these reasons, I ask the IRS to expand the definition of a direct primary care arrangement in the rulemaking to include a contract between an individual and a nurse practitioner, clinical nurse specialist, or physician assistant (as those terms are defined in section 1861(aa)(5) of the SSA) who provides primary care services under the contract.

Second, the proposed rule's definition of health care sharing ministries must be revised to accurately reflect the services that newer organizations can provide for patients. Currently, the proposed rulemaking specifies in Section 213(d)(iv) that for an individual to be eligible for the tax benefits associated with membership in a health care sharing ministry, that ministry must have been founded before and continually sharing medical expenses since at least December 31, 1999. This provision completely ignores the fact that medical cost sharing organizations formed in the last 20 years, or at any point in the future, could have better solutions for providing affordable primary care to more Americans. Many of my patients have membership in these cost-sharing organizations; l have worked with both legacy and non-legacy healthcare sharing companies and have noticed absolutely no difference in quality between the two. For this reason, subsection (iv) containing the "1999 requirement" should be eliminated from the proposed rule. There is simply no reason to deform the market with an arbitrarily-selected date, as no one can demonstrate that patients are benefitted differently by legacy and non-legacy cost sharing organizations.

The traditional health insurance system is outdated, expensive, stifles patient choice and participation in their care, financially punishes creative thought and individualized care, and does not sufficiently meet the needs of many American families. I believe that direct primary care arrangements, coupled with innovative medical cost-sharing organizations, is a sustainable model for quality and affordable health care. l urge you to take my comments into account and revise the proposed rulemaking: the IRS should be doing everything in its power to expand patients' ability to spend their healthcare dollars as they see fit, and remove the financial constraints third-party-payers force on them. DPC and unfettered medical cost sharing organizations are health care alternatives that are increasing preventative care and improving relationships between providers and patients. Thank you for considering my position and experience in the industry as you revise the proposed rulemaking.

Respectfully

Daniel Stock, MD
PureHealth Functional Family Medicine
Diplomate, American Board of Anti-Aging and Regenerative Medicine