How We Got Here - Reimbursement Transparency
Since we began notifying patients and the community of our transition from a fee-for-service medical clinic to a direct primary care clinic ten days ago I’ve been met with anxiety, frustration, anger, and skepticism. As many of you have not walked with us through the decision process, I felt it would be helpful to share some of the key points that led up to this decision.
The central theme to our frustration for many years has been reimbursement. Two of the largest suppliers of insurance, Medicare & Medicaid/DSHS, use a complex accounting formulation to calculate reimbursement rates for hospital owned clinics and non-profit clinic groups (Community Health). However, for a private stand-alone clinic, like ours, there is a flat rate offered, regardless of whether that flat rate covers the clinics cost. As you can see in the provided graphs, Family Health Care receives a flat rate far below what Community Health of Central Washington or Kittitas Valley Healthcare is paid.
Why does this matter? In this skewed reimbursement model private clinics are unfairly reimbursed less than larger medical groups. The lower reimbursement contributes to lower salaries for the providers of a privately-owned clinic – which impacts recruitment of new providers to a rural area when other providers move out of the area.
As many of our patients know we had two providers leave in the past year, Dr. Mongrain moved to Spokane in October of 2018 and Dr. Arar transitioned to an Urgent Care in Moses Lake in January 2019. At the end of September Dr. Druschel will move to Arizona to be closer to family and Dr. Walters will be moving in December to Oregon to also be closer to his family. With the loss of four providers and despite recruitment for new providers over the past year, we have no replacements in the pipeline for those four physicians we’ve lost.
The remaining four providers left at Family Health Care, Dr. Haney, Dr. Vaughan, Aaron Long, ARNP, and myself were left to determine how we would continue in a broken system with unequal reimbursement, increasing demand for more documentation from insurance companies, and further time spent justifying our medical rationale to non-medical employees of insurance companies attempting to quickly deny care to our patients. The epiphany was Direct Primary Care. No longer do we need to deal with insurance companies meddling in our appropriate care of our patients. No longer will we be running in an unfair reimbursement race with Medicare & Medicaid. No longer will we spend nights alone charting after the patients have left and our own families are asleep.
Direct Primary Care is a model that increases our availability and time spent with our patients, allows us to continue to serve and provide excellent care, and gives us back our time to be present with family and friends. I hope you’ll consider joining us as we transition to Compass DirectCare starting January, 1, 2020.
Ryan Beachy, PA-C