DPC Bill Still Allows Government to Dictate Standards of Care

Dr. Chip Smutny writes:

As I read about the AAFP endorsement of S 1989 I see we still have people in our organizations thinking that we can still play the government game at least partially.

“To participate in the demonstration project, DPC practices would have to meet performance targets established by Medicare. Qualifying practices would be required to offer enhanced services, including preventive care, wellness counseling, primary care, care coordination, appointments seven days a week, secure email and phone consultations, and 24/7 telephone access to consultations. If they failed to meet the targets for two consecutive years, they would be excluded from the initiative.”

This is still allowing government to dictate standards of care that they cannot support with data or even case studies that have any real statistical power.

Their idea of enhanced service is something we have strived to provide for decades with the exception of 24/7 access to consultation (whatever that really means and 7 days a week appointments in a single physician model. All of that has been done in a multi physician practice with advanced planning and rotating coverage as part of the teams plans.

Does every physician have to become a doc in the box to qualify for Medicare. Do we really want to have anyone telling us what to do so that we can get paid less and provide lesser quality standards of care because they are holding the patients purse strings?

DPC means that patients decide what when and where to place their monies. They collect from their payers. We of what we are good at, taking care of them.

This is one step closer as stated but it is still being lead forward as a program that has government in control of patient dollars without direct feed back from the patients to have to consider in their mix.

We need to be outside that choke hold on quality, individualized care as medicine has proven is the best approach in the greatest number of circumstances.

Our product is quality of life, patients that feel better and can physically and mentally do better.

Patients can decide what they will pay for and physicians can offer services in a truly competitive market returning us to a real world proving model. Bureaucracy just drives up the price. Technology when used wisely, should be the tools that help the physician do their work better not the axe used to curb their hard earned income or put them out of business. Patient records should be privately held and secure with the physicians not in centralized data bases that cannot be securely protected. Centralized data submissions should be de-identified so as to protect patient identity and subsequent patient data abuses.

Insurances need only have a bill with diagnosis and summary of treatment delivered. They can determine what they will pay for with their patient population and what the patient will be responsible for with their Healthcare Savings Account. The insurance companies have never sustained a doctor patient relationship with third party physicians or physician groups and should not ever be able to decide what care is proper or not. They should revert to what they once were, strictly a payment for services rendered organization. Their product is financing healthcare not providing healthcare or regulating healthcare.

4 thoughts on “DPC Bill Still Allows Government to Dictate Standards of Care

  1. Dr. Smutny is correct and he say it well here: “This is one step closer as stated but it is still being lead forward as a program that has government in control of patient dollars without direct feed back from the patients to have to consider in their mix.

    We need to be outside that choke hold on quality, individualized care as medicine has proven is the best approach in the greatest number of circumstances.”

    The reason DPC works is not simply HOW we are paid but WHO pays us. All these value-based payment models (ACO, PCHM and now this demonstration project) just succeed in putting more barriers between doctor and patient, such that the recipient of care is not the payer of care. What is masquerading as “quality” initiatives but again, is really resource rationing and attempts to control of government costs, not about lowering true cost of care or about improving access. It is indeed capitation by another name.

  2. Thanks for sharing. We shared similar concerns, and posted them on our Foundation blog about 6 weeks ago.

    Keep in mind that many want to own the concept of DPC, because it works. In some states, it is introduced by Republicans. In other states, it is introduced by Democrats. We must own this, as physicians, and keep this for ourselves and our patients. The beauty of DPC is that if you’ve seen one DPC practice, you’ve seen one DPC practice. We are all different. Our patients are all different, and that freedom to innovate needs to be preserved.

    The driving force behind the referenced bill is Qliance out of Seattle, WA (AKA, the DPC Coalition, now in conjunction with the AAFP). They are driving the bus. Qliance is the reason that DPC is in the ACA. They have millions of dollars in venture capital behind them, and must get an ROI. We are working to help guide this bill, and want to preserve our ability to contract directly with our patients, allowing individuality, but understanding that the Qliance model is different than what some of us envision for DPC. It is their position on acceptance of CMS funds that has kept me from joining the DPC Coalition, while we are often testifying side-by-side on the value of DPC.

    Despite some disagreements, the bill addresses critical concerns over IRS consideration of DPC that limit its rapid growth.


  3. It is very difficult to resist the tentacles of government overreach. It’s quite possible that “non-participating” providers will have their state licenses threatened. Of note, Hillary Clinton wants to get rid of health savings accounts, make it illegal for doctors to take cash payments directly from patients, & outlaw concierge practices.

    • Really? Omigosh! I had not heard that. Even more reason to stay away from Clinton, not that I would have supported her anyway. With such policies, patient freedom and choice will go totally down the train when they are already in the tank. I know that my health care choices in my area have become very limited by Obamacare.

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