By Jeff Clemetson | Editor

Grossmont doctor developing an alternative plan for health care

Health care in America is hard. Just ask the authors of any health care bill to date — no matter the intention — there are critics from one side of the aisle or the other lined up at town hall meetings ready to tear the plan down. However, one doctor at Sharp Grossmont Hospital in La Mesa believes he has some answers to the health care problem.

Dr. James Veltmeyer is a family medicine practitioner and although he was also a 2016 candidate for the 53rd congressional seat, he said his foray into the health care legislation debate is not a precursor to another run in 2018. His motivations are more personal.

In 2015, Veltmeyer’s wife Laura was diagnosed with aggressive breast cancer. It was an eye-opener to waste in the health care industry.

“Instead of having three PET scans, which is what she needed — one for diagnosis and two for surveillance — instead she’s had eight CT scans of the chest, abdomen and pelvis; she’s had three MRIs of the brain; she’s had two nuclear bone scan; a mammogram; and a bio X-ray,” he said.

Cutting the fat out of health care is the cornerstone of Veltmeyer’s plan, which he calls the Medical Association Membership (MAM). The MAM plan would utilize a direct primary care model where primary physicians and patients make health care decisions, rather than insurance companies.

In the case of his wife, he said, a primary physician could have sped up the process of getting a PET scan right away to diagnose the cancer, without the delay caused by mandates to get all the other tests that proved worthless and wasted valuable time that could have been better spent on treatment.

Direct Primary Care (DPC) is not a new idea or very widespread, but it is growing in popularity. According to a January 2016 report by NPR, the Direct Primary Care Coalition noted there were less than 20 DPC practices across the country before 2010. Last year, that number grew to 400.

DPC works much like a gym membership where patients pay their primary physician a monthly fee — usually around $100 — to cover checkups, lab tests and medication. Emergencies, hospital visits and care from specialists are not covered, so patients will still require catastrophic insurance for those services. Because the DPC model is mostly an added expense to the required insurance under the Affordable Care Act (ACA), it is often referred to with fancy names like “concierge” or “boutique” medicine.

“The only problem is that it is only available to people who do have money,” Veltmeyer said. “And I think everyone matters. I think every citizen is important and they should all have access to doctors.”

For doctors like Veltmeyer, the DPC model removes layers of paperwork and regulations, allows them to concentrate on patients, and the direct payments to doctors lower costs overall.

“If I can streamline my practice; if I don’t have a biller, don’t have a collector, don’t have to swim through an avalanche of regulations — if [doctors] can streamline that, and do without all that, you’ll have doctors that will see you for even $20, $40.”

Under Veltmeyer’s MAM plan, insurance companies would be cut out of direct care completely and everyone would be brought into the DPC model. Medicare patients would get a $100 per month voucher so they could choose their own doctor. Medicaid patients would get around $50.

Although Veltmeyer, a Republican, said he is against systems that socialize medicine, his plan does include subsidizing the needed catastrophic insurance for low-income earners who have emergencies or develop expensive medical conditions.

“What we do [currently] is we subsidize the insurance company, we subsidize the hospital, subsidize pharmaceutical, subsidize everyone,” he said. “But what I think is, it’s time to subsidize the individual.”

Veltmeyer sees the current system — where insurance companies are given large sums of money by the government and told to take care of communities — as an impediment to quality patient care.

“[Insurance companies are] not necessarily bad people, but their endpoint, their trade, is profit at the end,” he said. “So what do you think they’re going to do? Ration care.”

Another issue he sees with the ACA that would be fixed with his plan is the shortage of primary care doctors. When the ACA passed, millions of new patients suddenly needed to see a primary doctor at the same time, and because of the way insurance payments were structured, becoming a primary care doctor was less desirable than going into specialized medicine, creating a shortage.

“When a Medicaid or Medicare patient goes into the ER, the state supplies $150. The doctor used to get 80 percent of that,” he said. “Now that money goes to the insurance company before the doctor is given whatever is left. Sometimes as little as 4 percent.”

Because of the DPC model’s direct payments feature, more doctors would choose primary care and according Veltmeyer, that would reduce health problems, and costs, overall.

“There will be an impactful way of reducing the number of people coming to the ER because you will get maintenance and preventative medicine — and that’s the essence of healthcare and keeping you healthy,” he said. “The boutique model prevents up to 90 percent of people getting readmitted for heart failure, lung disease and so forth. It decreases 70 percent of ER visits.”

Those results, according to Veltmeyer and other proponents of DPCs, would drastically reduce the cost of catastrophic insurance.

The MAM plan is still in the drawing board phase, Veltmeyer said, but it has already garnered endorsements from conservative groups like the Cato Institute and The Heritage Foundation, and politicians, such as U.S. Reps. Duncan Hunter (R-California) and Andy Biggs (R-Arizona).

“My plan is to build a foundation to hopefully be able to enact this legislative amendment to the current health care bill,” he said. “I’ve been contacted by numerous congressmen, so right now I’m working with multiple organizations in developing a booklet. I’m hoping after the summer recess I’ll be able to present this to Congress.”

Considering the current political climate surrounding health care, Veltmeyer’s plan will have a difficult time being implemented. But despite the arguments on what the solution to our health care is, the problem is viewed the same from both sides of the aisle.

“This is what I know,” he said. “We live in the richest country, in a very wealthy country and we have the best medical supplies, best doctors, best technology and yet we fail to provide affordable, quality care for our citizens.”