Bill would create Medicare direct primary care pilot project

A bill unveiled in November would create a pilot program in which Medicare pays certain practices up to $125 per patient per month for providing medical homes through a version of retainer care called direct primary care.

Rep. Bill Cassidy, MD (R, La.), is sponsoring the bill, called the Direct MD Care Act of 2011. Direct primary care practices offer unlimited or less-restricted access to physicians for a set fee, sometimes less than $100 a month.

Dr. Cassidy said health insurance reform isn't enough to improve health care. "We need a system that leads to greater access for patients and lower costs."

The measure would create at least one pilot project in which Medicare pays direct primary care practices with more than 3,000 patients up to $100 a month to provide comprehensive primary care to beneficiaries. The fees would increase to $125 a month for patients eligible for Medicare and Medicaid. Each direct primary care medical home would be required to offer a typical range of primary care services, plus office appointments seven days a week, email consultations, and 24-hour phone consultations. The practices would report their patients' emergency department visits, hospitalizations, surgeries, specialist visits and use of advanced radiology.

HHS has awarded or will award several grants created by the national health system reform law to support innovation in health care delivery. Some of these could involve direct primary care practices, but none would focus on the specific impact of such practices on patients' health the way this bill would, according to Erika Bliss, MD. She's president and CEO of Qliance Medical Management, a direct primary care practice in Seattle.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2011/12/19/gvbf1219.htm.