A Wichita DPC Founder Says Price Mandates Fail. The Senate Bill He Answered Has a Billing Rule With No DPC Exception.

Josh Umbehr has run a direct primary care practice in Wichita since 2010, and he says practices like his post their prices on the front door. In an October 10 opinion column, he told Kansas Sen. Roger Marshall that writing that habit into federal law for hospitals won’t get patients what they want.

“Mandating price tags is the easy part,” Umbehr wrote. “Getting real, lower prices is harder, and the fastest way to get them isn’t restrictive government policy.”

Umbehr is a Wichita family physician and the founder of AtlasMD. His target is Marshall’s Patients Deserve Price Tags Act, S. 2355. The Senate HELP Committee ordered it reported on July 22, and it has sat on the Senate calendar since July 27, according to its official bill status record. No floor vote has been recorded.

The column argues from the hospital side. Read to the end, the reported text also holds a section that lands closer to a DPC practice than any hospital rule does.

Umbehr’s case against the mandate

Hospitals have been under a federal price-transparency rule since January 2021. Umbehr wrote that six months in, a nationwide audit found 5.6% of hospitals complying. “Two and a half years in, only over 36% of hospitals are compliant,” he added.

His explanation is incentive. Medicare pays a hospital-owned clinic more than an independent one for the same visit, he argued, and that gap funds acquisitions. In Kansas, he wrote, “56.5 percent of hospitals now sit in highly concentrated or monopoly markets.” His fixes are to tie hospitals’ benefits to posting usable prices and to pass site-neutral payment through the Same Care, Lower Cost Act.

Then he turned to his own model.

“Direct primary care practices, thousands of them nationwide and dozens across Kansas, post their prices on the front door like a gym membership,” he wrote. “A patient walks in knowing what the visit costs because when you charge patients directly, hiding the price is bad business.”

DPC Insider made a version of that point in June, when a House transparency bill cleared subcommittee. That bill, H.R. 9393, is the Lower Costs, More Transparency Act of 2026, a separate measure from Marshall’s. His bill’s House twin is H.R. 5582, which hasn’t moved past committee referral since September 2025, per its own status record. H.R. 9393 went further. It was ordered reported by the full Energy and Commerce Committee on a 45-0 vote on July 21, per its bill status record.

What the Senate text asks of labs and imaging

Most of S. 2355 aims where Umbehr aims. Hospitals would post standard charges, discounted cash prices and insurer-specific rates. Daily penalties scale with bed count, reaching $35 per bed per day for a hospital over 500 beds that stays out of compliance past a year, according to the reported text.

Sections 3 and 4 reach the places DPC patients get sent. Clinical labs and imaging providers would publish a gross charge, a discounted cash price and every payer-specific negotiated rate for each covered test or scan. They’d also have to name anyone holding an ownership or controlling interest, management services organizations included.

The bill defines the discounted cash price as the lowest dollar amount the provider accepts as payment in full from someone paying cash, regardless of insurance. A lab’s posted price must fold in specimen collection and other routine add-ons. A senior executive has to attest that the lab’s disclosures are accurate.

Those rules would start January 1 of the first year beginning at least one year after enactment. Penalties for labs and imaging providers start with a cap of $300 a day, and HHS could raise that cap through rulemaking for failures in 2028 or later.

If you price out a patient’s MRI by phone today, you might eventually be able to check that quote against the imaging center’s own published cash price.

The section that reaches past hospitals

Section 11 is titled “Transparency in Billing.” It applies to “a health care provider or health care facility that requests payment from an individual.”

Any such request would have to include written notice of the patient’s right to an itemized bill. The notice must list a phone number and website for requesting one, information on language-assistance services and the provider’s charity care policy. A provider could not bill the patient or take collection action unless it gave that notice or met the HITECH itemized-bill rule described below. Penalties run up to $10,000 for each failure to comply.

The same section amends the HITECH Act. A patient who asks only for an itemized bill would get it within 30 days, at no charge, with billing codes for each item.

The bill never uses the words “direct primary care” or “membership.” It doesn’t say whether a monthly membership invoice is a request for payment for “providing a health care item or service.” The section tells HHS to implement it “through notice and comment rulemaking,” so a rule could settle that question, and so could a court.

So the practices Umbehr holds up as needing no mandate could still end up under a billing-notice rule built with hospital bills in mind.

The case for the mandate anyway

The strongest reply to Umbehr comes from his own numbers. By his account, compliance rose from 5.6% to roughly 36% under a rule he says hospitals game easily. That’s a weak rule moving the needle, and S. 2355 is written to be harder to game. It writes maximum hospital fines into statute: $300 a day for hospitals with 30 or fewer beds, the same base maximum the current CMS rule sets before its annual inflation adjustment, and $12.50 to $35 per bed a day for larger ones, against the rule’s base maximum of $10 per bed, up to a $5,500 daily cap. It also adds executive attestation for labs and limits on HHS’s power to waive or reduce hospital penalties. Sen. John Hickenlooper, the bill’s lead Democratic cosponsor, said in Marshall’s committee press release that it backs disclosure “with real fines, not empty threats.”

The posted price in Umbehr’s example is also the price of the visit. When a DPC patient needs an MRI or knee surgery, that care happens at an imaging center or hospital, and those are the prices S. 2355 goes after. And by Umbehr’s own Kansas figure, more than half of the state’s hospitals sit in highly concentrated or monopoly markets. In those markets, the competition he wants may never show up on its own.

Where his argument holds is the distinction in his first line. S. 2355 is mostly a disclosure bill. Section 11 bars billing a patient above the disclosed price or good-faith estimate. Its one exception covers added items documented as medically necessary because of an unforeseen complication or a change the patient initiated. The cap is the price the hospital discloses, and the hospital still sets that price. The bill also leaves alone the site-of-care payment gap he blames for consolidation. The bill could hand DPC physicians usable cash prices for their referrals while doing little about what a hospital in a one-system town charges for the same knee.