SOURCE: Direct Primary Care Coalition

December 06, 2011 11:20 ET

Direct Primary Care Coalition Lauds Rep. Cassidy and Rep. Inslee for Bi-Partisan Bill to Pilot Flat-Fee Health Care for Medicare/Medicaid Dual-Eligibles

New Legislation Would Bring Direct Primary Care to People Enrolled in Both Medicare and Medicaid, Improving Access and Quality for Those Most in Need While Reducing Costs

SEATTLE, WA--(Marketwire - Dec 6, 2011) - The Direct Primary Care Coalition, an advocacy organization of primary care doctors, today announced its support for the Direct Medicare and Dual Eligible Care Act (Direct M.D. Care Act), sponsored by Rep. Bill Cassidy (R-LA) and Rep. Jay Inslee (D-WA) that was recently introduced.

The bill would create a demonstration program at the Centers for Medicare and Medicaid Services (CMS) in which Medicare would pay a direct primary care practice or doctor a flat monthly fee for primary care services and preventive medicine for Medicare beneficiaries and those who are "dual eligible" for both Medicare and Medicaid, such as low-income elderly and persons with disabilities.

The legislation would enable CMS to measure the downstream cost savings and health benefits that result from providing Medicare and Medicaid beneficiaries with unrestricted access to direct primary care for a low, flat monthly fee. The limits would be up to $100 per month for Medicare and $125 for Medicaid. If the bill becomes law, direct primary care providers who participate in a CMS pilot project will regularly report on the progress of their patients with chronic conditions, to track their emergency room visits, hospitalizations, surgeries, specialist visits and use of advanced radiology. Direct primary care can significantly reduce downstream health expenditures for the most costly population in our health care system: Medicare and Medicaid dual-eligibles, for whom per-capita spending accounts for more than $20,000 per year. By comparison, costs for dual-eligibles who participate in the CMS pilot project would average up to $1,500 per year, excluding any specialist or emergency services.

"The Direct Primary Care Coalition commends Representatives Cassidy and Inslee for their insight and ability to see the potential of direct primary care medical homes to significantly reduce the cost of caring for America's sickest and poorest population by providing easy access to high-quality primary care," said Garrison Bliss, MD, co-founder of the Direct Primary Care Coalition, who is also co-founder and Chief Medical Officer, Qliance Medical Management Inc., which operates five clinics in Washington state. "Direct primary care has already been shown to lower overall health care costs in the private sector by reducing ER visits, hospitalization days, surgeries and specialist visits by remarkable numbers. This important legislation would enable CMS to recognize the very same benefits for the most expensive population in our health care system."

Dr. Bliss pioneered the DPCMH in the state of Washington more than a decade ago. Direct primary care medical homes (DPCMHs) now exist in more than one-third of U.S. states, offering affordable health care alternatives to nearly 100,000 Americans.

Today, benefits of direct primary care membership can vary by provider, but these practices typically have one thing in common: in lieu of insurance, DPCMHs charge one low monthly fee -- between $49 and $129 per month -- for unrestricted access to primary care, preventive and chronic care management. There are no deductibles, co-pays or limits for pre-existing conditions. Many offices are open for extended hours and on weekends, and patients enjoy same- or next-day appointments for urgent care needs. Direct primary care practices generally handle all routine care including vaccinations, routine blood tests, women's health services, pediatric care, on-site procedures (suturing, casting, colposcopies, etc.) and provide ongoing management of chronic diseases like diabetes, hypertension and obesity. As a "medical home" model, these practices also coordinate any needed specialist and hospital care.

The bill marks another example of growing federal recognition of the importance of the direct primary care model, which was also included in the Patient Protection and Affordable Care Act of 2010. Under health care reform, DPCMHs are eligible to operate in the insurance exchanges beginning in 2014 if bundled with lower cost wrap-around insurance plans, which is proving to cut health care costs for individuals and employers by as much as 50 percent.

For more information about the benefits of flat-fee practices for patients and doctors, visit the Direct Primary Care Coalition at