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DPCare: Medicare and Medicaid

By The Direct Primary Care Coalition

JUNE 12, 2014 – There is near universal recognition that the current fee-for-service system cannot sustain good primary care. Lawmakers have been struggling for years to fix the problems created by S.2000, known as the Medicare Provider Payment Modernization Act (SGR), a method used by CMS to control Medicare spending on physician services. DPC Medical Homes were spelled out in House Energy and Commerce SGR legislation as an Alternative Payment Model (APM). DPC provides a clear pathway for a transition to value-based payment and will afford Medicare beneficiaries access to a personal physician to coordinate their care when they need it most—as they age and consume more healthcare services. Given that most Medicare beneficiaries suffer from multiple chronic—but highly treatable conditions, it only makes sense that Medicare patients would benefit from the added access to a primary care physician that DPC can give them. Consistently, data shows that patients in DPC practices have many fewer hospital days, ER visits, specialty visits, advanced imaging and unnecessary surgeries. They also have much more utilization of primary caregiver time and high levels of satisfaction with their experience in the health care system.

The SGR Repeal and Medicare Provider Payment Modernization Act of 2014 would repeal Medicare’s Sustainable Growth Rate (SGR) formula and allow Medicare to use this simple and innovative payment reform to permanently repeal the flawed Medicare SGR physician payment formula and would provide a pathway for DPC practices to be reimbursed by Medicare.

DPC is ideal for Medicaid patients. Several states have worked with DPC practices in capitated and risk sharing arrangements for DPC providers to manage primary care for Medicaid beneficiaries.

Source: DPCC — Read More at …


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