Any chance of getting the opting out regs changed to allow moonlighting?


(Dr Brian Pierce) #1

The traditional way of starting a primary care practice was to moonlight in the local ER until you could live off your practice income.

With DPC, opting out is important for growth but the current Medicare regs for opting out severely restrict moonlighting. Docs who want to convert, start or join a DPC practice are faced with staying in Medicare to allow moonlighting at the cost of severely restricting panel growth. Those who opt out can grow their DPC panel faster but have fewer or no (in rural areas) options for moonlighting to finance the transition.

Now that we have Dr Price at CMS, is this something that could be changed? When I talk to potential DPC docs, how to financially survive the transition year(s) is a huge hurdle. Fixing this would speed up adoption of DPC nationally.

(Dr Phil Eskew, DO, JD, MBA) #2

Hey @brianpierce this item has been on my agenda for some time. I would love to see HHS change the language in the Medicare Provider Manual to permit physicians to privately contract with any patient on a non-emergent case by case basis. As things stand right now we are left with a handful of moonlighting exceptions that I have described in detail here:

Some other language that the DPC Coalition originally recommended with the Primary Care Enhancement Act included other opt out exceptions for Medicare DPC pilots, but this small change is much less exciting than the larger change described above.