You Almost Had Me Back, AAFP


I saw this recent post on the AAFP website called AAFP Backs Senate Bill Supporting Direct Primary Care It says the AAFP is “supporting the efforts of a federal legislator who is throwing his weight behind the new care model. Sen. Bill Cassidy, M.D., R-La., has introduced the Primary Care Enhancement Act of 2015”, which enables patients to participate in DPC using their health savings accounts (HSAs).  The article goes on to say that “patients cannot use HSAs to pay for premiums under existing tax law, which has precluded many from choosing the DPC model.”  That is NOT true.  In fact, the issue is purposely murky.  The confusion is that the asinine IRS doesn’t want clarify what we are.  The HHS states we are NOT insurance companies so the HSA cards should be allowed. A bipartisan letter of big wigs was sent to the IRS last year to allow the HSA cards to be used with DPC clinics but the IRS is too busy targeting Republicans.  That is what inspired over 13 states to pass state laws allowing HSA cards to be used for DPC clinics. I guess the new bill is supposed to make that clearer?  The article states the “legislation removes a legal barrier that prevents patients with HSAs from entering into DPC arrangements with family physicians and other primary care providers” which is good.  It also wants to  provide “an avenue for patients who have HSAs, as well as patients enrolled in Medicare, to more easily avail themselves of services through the DPC model.” Uh, oh.  Now you lost me!  As the article states:

The legislation calls for setting up a CMS demonstration project for practices that wish to participate. Medicare patients can obtain DPC services now, but they must pay the monthly fees out of pocket and can contract only with physicians who opt out of Medicare. If the legislation is enacted, CMS would establish an innovative project that would pay DPC medical home practices a “periodic fee” for treating Medicare Part B patients.To participate in the demonstration project, DPC practices would have to meet performance targets established by Medicare. Qualifying practices would be required to offer enhanced services, including preventive care, wellness counseling, primary care, care coordination, appointments seven days a week, secure email and phone consultations, and 24/7 telephone access to consultations. If they failed to meet the targets for two consecutive years, they would be excluded from the initiative.

I am not a leader in the DPC community, but I am calling out to ALL DPC DOCS.  Do not let Medicare back into your lives!  Do you want “performance targets”?  If you opt out of Medicare you do not have to play the HIPAA game.  Do you want this crap again?  To paraphrase a line from Something about Mary, they can kiss my f&%in’ hairy beanbag.

Once again the AAFP sucks and has no idea what to do with us. 


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “You Almost Had Me Back, AAFP

  1. R Watkins
    September 28, 2015 at 12:02 pm

    I know that it’s a difficult, highly technical concept, but any chance of getting the morons at the AAFP to understand that if Medicare is paying the physician and making the rules, it’s the exact opposite of DPC?

  2. Pat
    September 28, 2015 at 8:33 am

    So Medicare will deal with DPC docs who have opted out of Medicare if those same docs will basically rejoin Medicare?

    And of course the Vichy AAFP would support this…

  3. Perry
    September 28, 2015 at 7:06 am

    It’s very ironic that the very reason docs are doing DPC is to get away from the BS required by the gov’t and insurance companies so they can provide real patient care (not “perceived” quality as defined by the government), yet here we have the AAFP inserting its foot in the door to support the same things that are driving docs out of traditional primary care and medicine altogether. They just don’t get it.

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