Bipartisan bill would introduce Direct Primary Care to Medicare and Dual Eligible patients

Please call your Member of Congress today and ask him or her to co-sponsor H.R. 3315, the Direct MD Care Act.

Reps. Bill Cassidy, MD (R-LA) and Jay Inslee (D-WA) have introduced H.R. 3315, the Direct MD Care Act, which would create a demonstration project allowing CMS to pay direct monthly fees to practices using the Direct Primary Care (DPC) model.  The program is aimed at gathering data to show CMS that DPC is a model that can improve health outcomes for patients and reduce health care costs for the Federal government. The ultimate goal is to enable the CMS Innovation Center to expand the model as an alternative to the fragmented care received by most patients in traditional fee for service Medicare and particularly those who are dually eligible in Medicare and Medicaid. 

Details on the program:

·       CMS would pay up to $100 per month for Medicare patients and up to $125 for dual eligibles.  Additional billings for covered services would not be permitted.

·       All primary care and preventive care services must be provided including urgent care services, wellness counseling and care coordination with specialists and hospitals.

·       24/7 access to care by email and phone must be provided for patients.

·       Only existing direct practices with experience in the model would be eligible initially.

·       Outcomes data on patents must be tracked and reported to CMS on an annual basis, including progress on emergency room visits and other hospitalizations, surgeries, specialist visits and use of advanced radiology

The number of practices involved and length of time of the demonstration are not specified, but would be subject to a rulemaking with CMS. Expansion of the program would be tied to the demonstration of Federal savings.  

Today, many Medicare patients already pay out of pocket for direct care outside of fee-for-service Medicare.  A growing evidence body shows that these patients actually subsidize a reduction in Medicare costs by staying healthier longer, avoiding costly ER visits, hospital stays and specialty care.  The DPC model allows physicians to spend more time with patients so that they can prevent and manage potentially expensive chronic conditions such as diabetes, heart disease and hypertension.  Furthermore, dual eligible patients could greatly benefit from more coordinated direct care, but cannot afford to pay any more for their care.  Duals make up a small percentage of Medicare, yet they account for 36 percent of Medicare spending and 39 percent of Medicaid spending.  Per capita spending on dual eligibles exceeds $20,000 per year and over half are under treatment for 5 or more chronic conditions which could be prevented or better managed with kind of highly coordinated care that patients in direct practices already receive. 

Reducing fragmented and uncoordinated care for in Medicare and among the dual eligible population will provide better health outcomes and significant savings.  H.R. 3315 can show CMS that the direct primary care model is a great alternative to current government run programs.  DPC enables physicians to practice the kind of preventative medicine they were trained for and the Direct MD Care Act will allow CMS to pay a reasonable fee for that care. 

Tell Congress that putting the doctor-patient relationship first is one way to improve healthcare for all and provide the savings we need to bring the best care available to all Americans.  If you don’t know who your Representative is, just go to http://house.gov/ and enter you zip code at the top right hand corner of the page.

Act today! Call, write or email your Representative today and ask him to co-sponsor H.R. 3315, the Direct MD Care Act.