by Katherine Restrepo
Director of Health Care Policy, John Locke Foundation
The Primary Care Enhancement Act of 2015 was introduced in Washington to help strengthen the presence of direct primary care (DPC) practices.
One component of the legislation calls for Medicare to pay providers a fixed rate for program beneficiaries seeking DPC. Federal rules in place today make it extremely confusing and a hindrance for Medicare patients to access a direct care physician. Physicians can treat Medicare patients, but can only bill for services not covered under the government payer – which leaves little room for health care delivery, considering Medicare part B covers most preventative needs.
To steer clear of violating Medicare’s Balanced Billing rule, DPC practices often resort to sign an agreement to opt out of Medicare completely for two years if they see a Medicare patient willing to pay out of pocket for care and not file any claims to be reimbursed under Medicare.
The Medicare alternative payment model (APM) under the Primary Care Enhancement Act has good intentions of opening up access to DPC for Medicare patients, but such a move could seriously undermine the main reason why DPC exists – remove government and middleman intervention so providers can actually practice the art of medicine and spend more time with their patients. If Medicare were to determine a set rate for physicians, this then sets a precedent for Medicare to get in the business of dictating the types of services doctors offer their patients in order to get paid.
A better approach would be to have Medicare distribute vouchers to patients and let them decide where to receive DPC services. There is no one-size-fits-all DPC. It’s best to keep it that way to empower patients with more choices to find a practice most suitable for them.