Direct Primary Care Belongs in Medicaid? Hmmm. I am not so sure.
First off, I welcome all comments but not if they are political attacks. This post is about whether Direct Primary Care belongs in Medicaid. I have a lot of worries about that. I am glad that DPC is being talked about. I think RFK, Jr. is sold on it. But with Medicaid?
- Does DPC really want the government involved in its oversight?
- What stipulations will you have when a Medicaid patient joins your practice? Can anyone say quality metrics?
- What’s to stop the government from changing the rules? The program could start as simple as an EBT-like card used to pay the membership but end up being something different every few years. Will you fire those patients?
- I remember a DPC group working with Medicaid once before when Direct Primary Care just started. How did that go?
- How many DINOs will be created to fraudulently capitalize on this?
What questions or worries do you have? Let’s be cordial and even if we disagree on this not be disagreeable.
He who pays the bills makes the rules.
Yep, you work for who pays you. I would certainly take an EBT-type card as payment and gladly take care of Medicaid patients, but that would literally be where it stopped. (Heck, I already take care of quite a few medicaid patients, they just pay me my affordable rates!) If they wanted data sharing, metric reporting, oversight or in any other way tried to get in-between my patient and me, it’s game over. And it’s very hard to imagine the government NOT demanding red tape and paperwork–they just can’t help themselves.
Amen Vance. I do too…take care of Mcaid folks. Our state honors my orders and prescriptions with little interference. Give me DPC liberty or give me death!
NO THIRD PARTIES!
I didn’t go through all the hard work to have a practice that I really enjoy coming to each day to let the government find a way to mess it up. No thank you, the government its error prone or oversight ways too many times for me to fall for that.
And…. Does anyone doubt that for the pleasure of getting entangled with federal and state Medicaid regulations which will undoubtedly accompany accepting their $, paperwork and reporting will escalate, requiring more office staff expense. No thanks.
DPC does NOT belong IN Medicaid. But could they work better alongside each other? Maybe more like Medicare does? Seems it actually MAY work that way in some states already, but not in NC. As others have said, I have a number of Medicaid patients that DO pay for my services – we just have issues with Medicaid refusing to cover my prescriptions and services like referral to GI for an EGD for example, or Orthopedics for their progressing knee arthritis. I totally agree that I would refuse to enter back into a payment agreement by a Medicaid program, or to their metrics or reporting of data.
Folks should be able to have Medicaid if they qualify – and it should cover prescriptions if the patients wanted or needed it to, and referrals to specialists, and certainly at hospitals for surgeries or other big expenses. It could function more like a healthcare sharing program for folks without the resources to afford those. But the recipients themselves could also pay the affordable membership fees at my office alongside that, if they so choose. It seems Medicare can peacefully coexist alongside DPC, maybe Medicaid could in each state too??
I am somewhat confident that a model for DPC participation in Medicaid, under RFK,Jr and Trump, would be a EBT-type or voucher model with minimal regulation. The main problems for DPC Medicaid PCPs and their patients would come in different ways but from the same general direction.
DPC Docs: There would be huge downward pressure on the amount paid for the monthly fee. Just imagine what legislators will hear from some of their non-Medicaid recipients the day that the local media start describing how Medicaid recipients have 24/7 access, lengthy and frequent PCP visits.
DPC Medicaid Patients: Early proponents of DPC in Medicaid relied heavily on the idea that DPC could bring the total health care costs for indigents by down by more than 50%; some actually claimed an 85% overall reduction. In their model, DPC would be coupled with Medicaid also paying for catastrophic insurance coverage. Medicaid as we know it would be replaced with DPC+ CAT; DPC + CAT is a model with which many D-PCPs are comfortable — quite amenable to minimal government regulation.
The principal problem for Medicaid recipients comes if the 50%+ or 85% reduction in overall health spending is unrealistic, because the amount of the voucher provided for the catastrophic insurance premium could then be far too low. While middle income patients might get CAT insurance — or a health share plan as a substitute — for modest premiums (or health share payments) that are reasonable, CAT coverage by definition comes with high deductibles. Almost no patient indigent enough to receive Medicaid, less than $1k month in many states, would be unable to afford the deductibles that come with real world CAT coverage.