Trump is Improving Medicare – Part IV


This is Part IV in a series of posts concerning improvements in Medicare being made by the Trump administration.

This new Trump policy is based on the idea of promoting choice, competition, and market prices.It seeks to do that in Medicare by:

  • Liberating telemedicine
  • Liberating Accountable Care Organizations (ACOs)
  • Ending payment incentives to hospital-based physicians
  • Promoting hospital price transparency
  • Deregulating paperwork
  • Increasing transparency in the market for prescription drugs

In Part I we discussed Liberating telemedicine. In Part II we discussed Liberating ACOs andEqualizing Physician Fees. In Part III we discussed Promoting Hospital Price Transparency and Price Transparency in the Drug Market.

Deregulating Paperwork

As a physician, I can testify to the increasing amounts of paperwork required of the American physician. It has reduced the amount of time physicians spend with their patients, increased the cost of doing business, and generally reduced the quality of care. Relief is certainly needed.

The Trump administration, through the Centers for Medicare and Medicaid (CMS) has launched a major initiative to do what most doctors believe is long overdue. Based on input from thousands of practitioners, the agency has made changes it estimates will eliminate 53 million hours of burden!

Reducing this burden will reduce costs by an estimated $5.2 billion over the first five years. This means more time for doctors to spend with their patients and lower costs of providing healthcare.

Concierge Doctors

You’ve probably heard of a new phenomenon in healthcare called concierge medicine. Some doctors now limit their practice to those who pre-pay for healthcare by an annual fee in order to guarantee less time waiting for appointments and easier access to healthcare. This form of practice has gained in popularity in recent years.

A similar type of medicine called Direct Primary Care is coming soon to Medicare.  Under this arrangement, Medicare would pay a fixed monthly fee to a physician or group instead of the traditional fee-for-service. In return, the physicians would provide virtually all primary care. Fees will be from $90 to $120 per month, depending on patient age and medical history.

As of March 2018, there were 790 direct primary care practices in the U.S. They generally provide 24/7 access to a physician and communicate by phone, email and Skype. Their benefits include:

  • Improved access to care
  • Improved quality of care
  • Reduced overall healthcare spending
  • High levels of patient satisfaction


Currently these practices generally do not accept Medicare. They are not allowed to contract with a Medicare patient unless they are in Medicare – and most are not. This requires a change by Congress to eliminate this Catch 22. Such a change would allow the elderly and the disabled to get the same tax break others receive when they buy healthcare from providers who aren’t governed by Medicare rules.

John C. Goodman, the author quoted throughout this series, says, “The Trump administration is clearly pushing the envelope – in many cases acting to fill a void left by Congress. These changes will result in a very different healthcare system. It will be one that is shaped more by individual choice and market forces than by rules and regulations.”

Republicans have been repeatedly accused by Democrats of having “no healthcare solutions.” Clearly, this is not true of the Trump administration.