Medicare: Enhancing the Doctor-Patient Relationship


Do you have your doctor’s cell phone number in case of a medical problem?

Does (s)he come to your place when you’re feeling unwell?

Those are among the potential hallmarks of an experimental model Medicare may be developing for primary care doctors and beneficiaries.

The model would allow the Medicare agency to contract directly with medical practices for increased access. 

Medicare would pay a fixed monthly amount per beneficiary to primary care or multispecialty practices in this “direct provider contracting” model. 

In exchange, the practice would be expected to offer beneficiaries enhanced access to doctors and services as well as be held accountable for their cost and quality of care. 

A big booster of the arrangement is a group called the Direct Primary Care Coalition (DPCC), whose 72 members are primary care practices that allow their patients unrestricted access for a fee.

Jay Keese, executive director of the coalition, told me direct primary care is already out there in the commercial world, offered through employers and unions.

The Medicare agency put out a request for information, known as an RFI, in April and took comments from the public in May on this proposal. The agency wants to know how the concept could be applied not only to Medicare but to Medicaid and the Children’s Health Insurance Program.

More time with patients would enable primary care doctors to diagnose and treat patients rather than shunting them off right away to a specialist, Keese said. 

“We’re trying to get away from the visit as the construct of the relationship between the doctor and the patient,” he told me.

Keese himself is in one of those relationships. His doc has limited office hours but for a flat monthly fee comes to the house when Keese’s family needs him, he said.

Keese wants to see that for Medicare beneficiaries.

DPCC recommends that Medicare deposit the per beneficiary monthly payment into beneficiaries’ medical savings accounts. 

There’s no claims or billing, Keese said. “Anytime they need a prescription filled, they either text or call the doctor.”

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