HHS to curb appointments with your primary care doctor

Excited about having a much-deserved seven-day “RTO”? Well, … a new kind of “RTO” will start, so it might end up being a month away. More details from HHS head Alex Azar.

Update: CBS News anchor Jeff Glor tweeted that the Women’s Health Advisory Committee was supposed to hold its monthly meeting on Aug. 27, but the schedule is now up for “review.” Friday, Aug. 31, is the last official date to come to the meeting, and there were doubts about whether it would actually happen. So, it went to Sept. 12. We’ll keep you updated.

Of note: the committee is working on a proposed rule to make the “RTO” go away. We don’t know when it will actually be published.

Here’s a little more from Azar, sent to the press by HHS:


Some PCPs (primary care physicians) are already “routinizing,” or taking and holding the following steps: 1. Routing patients to urgent care when necessary; 2. Moving patients to alternative providers or providers to give them priority (where patients fall within the “financial hardship” of the PCP); 3. Routing patients to telehealth or other kinds of coverage – including out-of-network coverage — if the PCP is in a situation where it is financially feasible to do so, or chooses to do so due to other factors; 4. Communicating with other providers, other insurers, or ordering costly tests that require a referral – to avoid the need for travel and trip to urgent care. Many PCPs routinely and strategically navigate – taking actions that would be considered “RTOs” under the same standards as other care settings – to avoid having to provide unnecessary care, which is not in their patients’ best interest.

What “RTO” does not include is avoiding taking important diagnostic and treatment steps (“determining an agenda and putting it in writing”) needed for the evaluation and treatment of patients with conditions that require urgent care (those who arrive at the PCP complaining of chest pain).

Examples of situations that “RTO” might prevent include appendicitis, uncomplicated appendicitis, advanced-stage pressure ulcers, very common emergency conditions like urinary tract infections (UTIs), potentially fatal allergic reactions to medications (and flushing skin reactions), chronic bronchitis and emphysema, diabetics who arrive with chest or back pain and chest pain, or those with acute heartburn or chills.

These “RTOs” will not give unnecessary care. But they reduce PCPs’ involvement in these cases, causing delays to follow-up visits and potentially sending patients to costly, unnecessary tests or treatments. We support an explicit ban on the use of RTOs as an intentional or inefficient way to avoid “routine clinical decisions,” and preventative care by other means. Because we know from our conversations with PCPs that taking the RTO action was usually because a patient could not afford to go to a provider or because of the financial challenges for the PCP – not because the patient needed to see a specialist. We need to adopt a clear definition of RTO, and codify the protections in the agreement rules, so it is clear that our commitment is to clearly providing access to care, not blocking access.

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