Doctors to leave Medicare for Direct Primary Care

By Dr. Eowyn
FEBRUARY 19, 2013 – U.S. physicians do not cotton to Obamacare or any form of socialized medicine. That is clear from surveys conducted through the years.

In March 2010, before Congress passed Obamacare, a survey by the New England Journal of Medicine found that more than 46% of primary care physicians (family medicine and internal medicine) said Obamacare’s passage would either force them out of medicine or make them want to leave medicine.

Two years later, after Obamacare became law, the percentage of disaffected doctors had markedly increased. A survey released by the Doctor Patient Medical Association found that a shocking 83% of U.S. physicians considered leaving their practices over Obamacare.

Now, disaffected physicians say they are leaving Medicare for direct primary care.

Bruce Japsen reports for Forbes, Jan. 30, 2013, that as Medicare whacks away at what doctors are paid and health insurers move away from paying fees for service to bundled payments, more physicians who own their own practices say they will leave Medicare for direct pay.

A national survey of nearly 14,000 physicians conducted by Merritt Hawkins — a physician staffing firm — for The Physicians Foundation, found that 1 of 10 (9.6%) of “practice owners” are planning to convert to direct pay practices in 1 to 3 years.

The movement is across all medical disciplines.

Mark Smith, president of Merritt Hawkins, explains: “Physicians have been running for cover for several years now. There is a lot of uncertainty in health care now and the only certainty is there is a lot of talk about cutting physicians fees. One way to get out of it is to go off the grid.”

Doctors are unhappy about the lack of a permanent solution for dramatic cuts to doctor payments from the Medicare health insurance program for the elderly under the sustainable growth rate (SGR) formula.

Already, one in five physicians is restricting the number of Medicare patients in their practice and one in three primary care doctors – the providers on the front lines of keeping the cost of seniors’ care low – are restricting Medicare patients, according to a 2010 AMA survey of more than 9,000 physicians who care for Medicare patients.

Under direct primary care, doctors contract directly with patients to provide all of their primary care needs free of insurance interference at a price generally between $50 and $60 a month per patient.

That is much cheaper than the “concierge medicine” found by some Congressional investigators, of $5,000 to $15,000 a year or more. Merritt Hawkins’ Smith said of direct primary care practice, which the New York Times dubs “concierge medicine for the masses”: “It’s not just for the rich and famous anymore. If you can afford a gym membership, you can afford this kind of care.”

The direct primary care approach provides unlimited visits to a physician’s office plus 24-hour access to doctors through e-mail consultations. The primary care model has drawn insurance industry opposition in part because the health insurer middleman is cut out of the equation as doctors are no longer paid by the likes of Aetna (AET), Humana (HUM) or a UnitedHealth Group (UNH).

Under a proposal under consideration by Congress and Medicare officials, a pilot program would provide “monthly fee-based payments for direct primary care medical homes” for certain Medicare beneficiaries, according to the legislation introduced by Congressman Bill Cassidy (R-Louisiana), who is a physician.

Supporters of the direct primary care approach see the pilots as a way to show Congress and an Obama administration eager to reign in Medicare spending, that the concept can provide quality medical care and lower costs.



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