One Medicare Opt-Out Still Closes Every Other Door

Right now Medicare opt-out is all or nothing.

If you opt out so your Direct Primary Care practice can take Medicare patients on a flat fee, that same decision follows your NPI into every other room. Hospitalist shifts. Hospice. Skilled nursing. Locums. Outside of emergency and urgent care exceptions, you cannot bill Medicare anywhere else. CMS is explicit: the choice is not selective.

That is the rule Resolution 504 puts in front of the AAFP Congress of Delegates this October. The New Mexico Chapter asked the Academy to fight for a partial opt-out by practice setting — keep the membership model in one door, keep Medicare billing in another. The AAFP puts the fiscal note at $27,000 and the political risk at low. Passing it only makes it Academy policy. Changing the Social Security Act is still Congress.

I am not shocked. Most physicians wear more than one hat. A 3-day DPC panel and 2 hospitalist days is how a lot of towns keep both doors open. Force the all-or-nothing choice and the hospital loses the moonlighter, the hospice loses the weekend coverage, and fewer doctors ever open the membership practice in the first place.

DPC doctors are now more than 11% of AAFP membership — the fastest-growing sector. They know the rule in their bones. One opt-out should not erase every other role that still serves Medicare patients who are not on a membership.

I am not anti-insurance. Keep a policy for the wreck. I am anti a paperwork rule that makes Direct Primary Care harder to staff while seniors still need a hospitalist down the hall. We take care of patients for a flat monthly fee. No claim. No network. The number on the door is the number you pay.

One opt-out is a decision. All or nothing is a shortage wearing a regulation.

Source: www.mydpcstory.com/post/aafp-resolution-504-partial-medicare-opt-out-dpc