by jordan blum
Advocate Washington bureau
May 27, 2012
The USA Network has a lighthearted TV show called “Royal Pains” about the trials and tribulations of a concierge doctor who caters to the rich and famous residents of New York’s Hamptons islands.
This is precisely the kind of image that much of the burgeoning concierge business wants to avoid.
The industry model, which is called direct primary care, wants to serve a lot more people — including the low-income and elderly — at relatively low costs, rather than exclusively cater to the so-called 1 percent at ridiculous costs.
The idea is that if businesses in the industry have enough patients, they can skip the insurance middle man and offer unlimited doctor visits and email access to medical staff for $60 or so a month without any premiums or co-payments. Patients likely would still pursue obtaining insurance for major medical and hospitalization.
The New York Times and Forbes magazine both featured the growing health-care model this past week, including legislation filed by doctor and U.S. Rep. Bill Cassidy, R-Baton Rouge.
Cassidy’s bill is dubbed the Direct Medicare and Dual-Eligible Care Act, or the Direct M.D. Care Act.
The legislation is designed to create federal pilot programs Centers for Medicaid and Medicare Services, called CMS, which would connect Medicare patients to direct primary care services for no more than $100 a month. The dual-eligible patients also linked to Medicaid would pay no more than $120 a month.
In a letter to his colleagues, Cassidy contended, “The results from one practice speak for themselves: over a two-year period, ER visits were reduced by 65 percent; hospitalizations were down 43 percent; while primary-care visits were up by 92 percent.”
The goals are essentially to rein in federal spending while expediting access to doctors for patients.
No one is saying this plan is the end-all solution or that everyone should use it. Younger, healthy people who do not frequent doctors’ offices probably won’t feel like forking over an extra $60 or so every month for access to doctors they don’t need. But the argument is there’s a growing nice market that is ripe for tapping into.
In one unique niche, The New York Times piece focused on direct primary care working great for truck drivers who are constantly on the road and are apparently notorious for chronic health issues. One Seattle-based trucking company signed on with the Qliance primary care provider, also based in Seattle, and the truckers reportedly are now much more proactive in making doctors appointments when health issues arise and saving money for most involved, according to the report.
The New York Times report stated, “Call it concierge medicine for the masses.” The Forbes headline read, “The Rare Bipartisan Health Idea: Affordable Concierge Medicine.”
So the next question is how to move forward with implementing some of these ideas?
The New York Times piece asserts that, if President Barack Obama’s health-care law is upheld by the U.S. Supreme Court, then direct primary-care practices can be permitted to offer plans on state insurance exchanges starting in 2014.
As a Republican who opposes much of Obama’s policies, Cassidy obviously doesn’t want to go that route.
But the reality in Washington is that stand-alone legislation like Cassidy’s bill is hard to successfully push through both chambers of Congress in this day and age of gridlock.
But Courtney Austin, Cassidy’s legislative director, said there’s some reason for her office to have optimism.
That’s where Congress’ sustainable growth rate, called SGR, comes into play. SGR was created in the late 1990s as a budget-control mechanism in part to keep Medicare spending in check. But the SGR has served as the proverbial can that’s kicked down the road and will have to be addressed again in some form or fashion in December.
Austin said one goal is to attach Cassidy’s bill to any SGR legislation that is approved. “Hopefully, we can bring more attention to this model,” Austin said. “It should be looked at.”
One imagines we’ll find out later this year.
Jordan Blum is chief of The Advocate Washington bureau. His email address is email@example.com.