Medicaid and Direct Primary Care
Here is some interesting news that keeps popping up over and over again:
The Medicaid Primary Care Improvement Act, a law that has passed in the House and is now under consideration in the Senate, seeks to expand the opportunities for direct primary care arrangements in Medicaid, according to an emailed press release from Sen. Marsha Blackburn’s (R-Tenn.) office.
Blackburn and Sen. Mark Kelly (D-Ariz.) introduced the bill in the Senate after it passed in the House. The bill seeks to improve access to care in rural areas.
Feel free to to read the rest of the article. I have said many times that I think Medicaid patients would do really well in a DPC system because they would get more time from the doctor to get their health issues controlled. There have to be stipulations from DPC docs, however:
- The Medicaid patient should have EBT cards that are just for the doctor. No one else.
- DPC docs cannot be billing the government and waiting for money. They would just swipe the cards.
- There cannot be ANY quality metrics. All of those have proven NOT to work.
- The key is NOT adding any bureaucratic work to the DPC doc because that is why they left the system in the first place.
Here are my fears. Since Medicald patients have no skin in the game they will abuse this. The government will start with just a few bureaucratic strings attached but it will add more and more slowly like the boiling water killing the frog. And DINOs will be the ones taking this whole thing over giving DPC a bad name.
Your thoughts?
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Being in the military I agree with the above stipulations. If you design the system correctly it can succeed but you have to be very careful because most systems end up having loopholes that someone will figure out and use to their advantage and take the plan down an unanticipated alley. The Medicaid patients will have to have some things in place because when care is free to someone they have a tendency to take advantage of it. Consider assigning a social worker assigned to each one (with the money saved from using the big healthcare systems).
The beauty of this bill is that it simply opens the door for each state to partner with DPCs. It will be up to us, the DPC doctors, to control how it’s implemented, tailoring it to meet the unique needs of each area. While similar agreements may have failed in the past, this time we are approaching it with greater control and a more strategic approach.
Spot on Doug.
Danger, danger! Beware when the govt says they’re here to help…
Always important for patients to have financial skin in the game.
absolutely – even more interesting is that there might be enough money in the food stamps budget to add direct care services without additional funding.
I do have some Medicaid patients in my DPC practice, who are able to manage their budgets so that they can pay for my services and receive the medical CARE that they have come to know and trust through our office. I suspect others do too. But these same patients are having to then self-pay for their prescriptions at the pharmacy, and sometimes see a PCP at the Health Dept or at a Medicaid-providing office just to get a referral to Hematology, for example, that will be covered by Medicaid. My “simple” request is that Medicaid would honor my prescriptions at the pharmacy, and honor my referrals to specialists when needed! I certainly refuse to report metrics – I don’t want to get dragged back into the system at all – but I’m willing to play nicely with others, to the benefit of the patient!
Thanks for commenting on a bill without bothering to talk with anyone on the front lines about what the bill says or how it would work. The original bill was written last year by a Pediatrician (Kim Schrier MD – Dem in Washington State) and Dan Crenshaw (Rep in Texas). The bill says NOTHING about payment and commits NOBODY in DPC to participate. All it does is to make it possible for states to negotiate directly with DPC doctors who want to work in Medicaid without requiring that the state get permission for an “exception” at the Federal level. Exceptions have killed any interest in even trying to work with DPC docs at the state level, even when state Medicaid programs voiced an interest in paying us our full DPC fees to get the downstream cost savings and to allow their Medicaid patients to use are remarkable services.
I know a lot about how Medicaid works and doesn’t work. I think you already know that. You can’t fix this problem with paranoia. Medicaid patients deserve better than the Medicaid mills. What do YOU plan to do about it?
The comment was about not the bill, specifically. It brings up the issues of being involved with the government again. Go back to yelling at the clouds from your lawn.