Episode 131: Colorado Threatens to Take Away Your License if You Don't Play Ball with Dr. Belen Amat

 

This year, the Colorado legislature introduced a bill to radically change the way health care would be delivered in the state. HB 21-2132 was introduced this year with the hope of creating a public option health insurance for everyone in Colorado. In essence, the insurance product created by the state would set minimum standards for coverage and be available to anyone. Of course, their expectation is that they will lower health care expenses by over 10% with this plan. If this doesn't happen, the hammer comes down on everyone providing care.

What Happens if it Doesn't Save Money?

Not surprisingly, the legislators recognized that health care systems and people who provide care might not actually provide the care needed at the reduced rates the new insurance was offering. If that happened, then medical care wouldn't be cheaper and the plan would fail. But how would the lawmakers get doctors and physical therapists, pharmacists, chiropractors, etc to accept the low reimbursements to make the plan work?

Well, not surprisingly they decided to force all the people who provide care to accept those reduced rates or lose their ability to work. They accomplish this by taking away professionals' license to practice medicine, PT, OT, etc. by claiming that it is unprofessional behavior to not accept their fee schedule. And that is where the real opposition to the bill began.

What Happened to Phase 2?

The threat of losing your ability to practice for anyone who accepts medical payments generated a huge amount of resistance within the state. And not just from doctors but large health care organizations, massage therapists, chiropractors, physical therapists, chiropractors, podiatrists, or basically anyone who provides any sort of medical service. Everyone was at risk of losing their ability to practice if they failed to accept the insurance or perhaps go bankrupt if they did accept the payments and they didn't cover their costs.

Naturally, when insurance companies, hospitals, and medical organizations are all lobbying against the bill you have just too much money to fight as a legislator. It is easier and safer to acquiesce and amend the bill to remove all of the punitive provisions. In a moment of honesty the lawmakers have to know the plan will then fail without and provisions to force cost savings but it is easier to just pass a symbolic bill and maybe hope you get what you want later when it fails in practice.

What was the Risk to Direct Primary Care Doctors?

Obivously, the great risk to DPC doctors was that they already work outside the insurance system by directly contracting with their patients. So any plan that forces them to take insurance immediately removes a lot of the efficiencies they gain by running a lean office and not using billing services. Also, they operate outside the insurance system which jacks up the prices as we've discussed on numerous occasions here, here, here, and here, among others. So suddenly DPC doctors, who operate entirely outside of the system, were going to be required to jump into the third party payment system or risk losing their medical license.

It was total madness and fortunately the bill was amended before some doctors had to look for work somewhere outside the state.

So What's the Takeaway from this Near Miss?

It's simply this, you have to pay attention to what is going on at your statehouse or have someone close to you who is paying attention to warn you when bad legislation rears its ugly head. It's probably also important to meet with your state senators and representatives to talk to them about what you do and how you practice. Maybe show them your office or explain how you care for people who are too rich to get medicaid but too poor to be able to afford their own insurance. It's always best to do this when there isn't legislation pending so they know that you exist, how you operate, and the vital service you provide for so many patients. You never know when they will need a phone call to discuss amending a bill to let you practice the way you want.

Dr. Belen Amat is a direct primary care physician serving the greater Grand Rapids, MI area. She also serves as a board member on the Michigan State Medical Society.

 

 

 

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show notes

Episode 131: Today's show

DPC West Michigan: Dr. Amat's DPC Practice

Colorado HB 21-2132: The legislation in question that seeks to create a public option for residents in Colorado. Since amended to remove the more onerous portion that stripped medical practitioners of their licenses and ability to practice.

How did HB 21-2132 Change?: This is a good accounting of how the legislative process unfolded and the various political players involved.

Episode 002: Dr. Amat talks about her journey away from third party payment medicine to direct primary care.

Episode 105: What is the One Question You Wish You Knew Before Starting a DPC Practice?

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