Why is the Direct Primary Care (DPC) payment model not available to Medicare patients?

/Why is the Direct Primary Care (DPC) payment model not available to Medicare patients?

Why is the Direct Primary Care (DPC) payment model not available to Medicare patients?

While many states including Washington have embraced the  monthly membership format to improve the quality and affordability of primary care, Medicare hasn’t had the bandwidth to embrace it yet.  Because Medicare is a federal program, the rules surrounding direct primary care are different than those supported by Washington State.  For starters, membership medicine seems to run afoul of Medicare’s policy that a practice must submit a specific claim and receive a specific fee for each service rendered. They regulate against underbilling and differently-billing. That said, Medicare has recently put out a request for proposal for how they might best integrate a DPC membership primary care option for their patients. Time will tell, but we are optimistic. For now, because Medicare laws require us to bill for covered services, we can only offer the Concierge Medicine payment model to our Medicare patients for our membership only practice.  The Concierge Medicine payment model allows our Medicare patients to participate in membership medicine and provides additional non-covered services such as personal training sessions. 

By | 2018-08-21T23:02:20+00:00 January 9th, 2018|0 Comments

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