Ten years after the Texas Legislature passed a law allowing primary care physicians to enter into a certain kind of direct payment arrangement with patients – bypassing the process of receiving reimbursement through insurance companies – state lawmakers have extended that option to specialists.
House Bill 541, in effect as of June 20, expands the usage of what’s popularly known as direct primary care, into a new statutorily-defined term, “direct patient care,” which, among other provisions in the bill, authorizes a Texas-licensed physician or health care practitioner to enter into a written agreement with a patient to provide health care services in exchange for a direct fee for a specific period of time.
In a typical direct primary care model, patients pay a monthly fee, and in return, receive services like office visits and in-office procedures without involving insurance.
The bill’s 2015 predecessor, the Texas Medical Association-supported House Bill 1945, was specific to primary care physicians. HB 541 changes that language to now authorize physicians, and other health care practitioners, to enter into direct care payment arrangements to provide a “health care service,” which is defined as, “any care, service, or procedure provided by a physician or health care practitioner.” The term includes any “medical or psychological diagnosis, treatment, evaluation, advice, or other service that affects the structure or function of the human body.”
HB 541 also makes clear, as HB 1945 did, the payment arrangements are not considered an insurance product, and a physician or practitioner providing direct patient care “is not subject to regulation by the Texas Department of Insurance.”
Thomas Kim, MD, an Austin-based psychiatrist who has developed a ketamine-assisted psychotherapy program for patients, says the new law makes possible the chance to take “more control of [his] destiny” and create a psychiatric direct patient care model.
“Direct care is a direct response to how complicated and unhelpful the reality of health care is today,” Dr. Kim said. “More and more people are struggling, not just with the ability to pay … but the satisfaction. We’ve lost the connection, the doctor-patient therapeutic relationship, and I think direct care has an enormous potential to restore the importance of that relationship.”
Amy Townsend, MD, chair of TMA’s Committee on Independent Physician Practice, has been using direct primary care in her Bridge City family medicine practice since March 2020.
She advises physicians interested in utilizing a direct care model to look at all the current regulations before moving forward, emphasizing resources exist to help physicians navigate the transition.
Visit TMA’s resources on independent physician practices, and learn more about TMA’s work on insurance issues during the 2025 legislative session.
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.