JEFFERSON CITY, Missouri — Some doctors want to make Missouri's Medicaid program a little more like a health club.
A proposal outlined by a pair of doctors Tuesday would create a pilot project in which primary care physicians would be paid a flat monthly amount for each Medicaid patient they accept. The patients then would be entitled to an unlimited number of visits, phone calls or emails with their doctor's office with no co-payment or deductible.
Just like a personal trainer can cost extra money at a health club, the cost of a medical specialist or hospital visit would be above and beyond the flat fee for primary care physicians. Such costs would be covered through a high-deductible health insurance plan coupled with a health savings account for Medicaid recipients.
The proposal by Republican Rep. Keith Frederick, an orthopedic surgeon from Rolla, was endorsed during committee testimony Tuesday by Dr. Sonny Saggar, who already offers a similar plan for non-Medicaid patients at his St. Louis Urgent Cares clinics.
Saggar and Frederick contend their proposal — known as "direct medical care" or "direct primary care" — could result in better health care for patients at potentially lower costs to the Medicaid program.
Instead of carrying a roster of thousands of patients, doctors likely would limit themselves to 400 to 600 patients — thus spending more time with each patient. Saggar and Frederick said smaller caseloads and guaranteed money could be appealing to doctors who are now hesitant to accept Medicaid patients because they are reimbursed at lower levels than privately insured patients.
"Under this system, you'll have doctors lining up to take Medicaid," Saggar said.
Reaction was mixed from members of the House Interim Committee on Medicaid Transformation, which has been studying a variety of ways to remake the health care program for the poor. As of October, nearly 858,000 Missourians were enrolled in the state's Medicaid program, dubbed MO HealthNet.
Republican legislative leaders have said they want to improve Missouri's current Medicaid program before considering Democratic proposals to expand eligibility to more lower-income adults. A Medicaid expansion would be paid for largely by the federal government under the terms the 2010 health care law signed by President Barack Obama.
Rep. Gina Mitten, D-St. Louis, raised several questions about the doctors' proposal, including whether physicians would have an incentive to try to maximize profits by providing fewer services to patients.
Rep. Jeff Messenger, R-Republic, questioned whether the doctors' proposal could hurt the economy by taking away business from other health care companies, like those that specialize in selling medical equipment.
The House committee is to develop recommendations for Medicaid changes to be considered during the 2014 legislative session.
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