Embrace the Joke by Pat Conrad MD

The amount of dishonesty that has now become the foundation and coin in medicine is maddening, disheartening, and funny. Watching goofy primary care types head fake themselves into worse economic shape has at least got to be good for a laugh. The good folks at Medical Economics will obviously print anyone (they’ve run my stuff a few times), and that includes Salvatore Volpe, MD, pediatrician, who cranked out a sweet primer on embracing the Primary Care Home concept.

Step 1: Accept the PCMH as good, necessary, and inevitable. The Patient-Centered Primary Care Collaborative “focused on quality and safety.” Hehehe, just try arguing with anything that favors quality, safety, puppies, or sunshine.

Step 2: Support your acceptance of PCMH by stating how big the problem is, inferring that magnitude defines imperativeness. “Population-based care is pro-active in nature and does not involve face-to-face interaction, is often uncompensated, and can account for more than 25% of the time” of the staff . So we gotta do something!!

Step 3: Justify the mandatory nature of the PCMH by rattling off a chain of acronyms that are the veritable ass abscesses of real practicing physicians: The Association of Academic Health Centers, The Joint Commission, the National Committee for Quality Assurance, and the Utilization Review Accreditation Commission, all organizations who preserve the safety of their own bank accounts by forever finding new faults with the “quality” of those doctors and hospitals who keep rolling belly-up for approval.

Step 4: Once an unsustainable idea is formalized, pack further layers of assurance around it. A high-sounding ideal must be defended, no matter how bad an idea it is in practice: “The Affordable Care Act led to varying degrees of enhanced reimbursement for Medicaid and Medicare providers while multiple commercial plans also offered to increase payment to practices that qualified. Unfortunately, these programs were not universally implemented and many are at risk of ending if not renewed by the federal and state governments.” But should not a practice that qualified be more efficient in controlling long-term costs? Should not such a practice be more cost-efficient in the short term, by the increased energy and timeliness of its clinicians as they are more able and motivated to jump on the email requests without having to see increased numbers in the lobby? Surely the bonuses for qualifying programs made up for any revenue shortfall from seeing fewer patients…?

Dr. Volpe shows that the PCMH concept is by his own definition unsustainable i.e. can’t work without subsidies from somewhere. He then – and this is the funny part – ignores this core fault and blames the failure of the concept on “these programs [not being] universally implemented.” Translation: this unworkable idea is not yet widespread enough: “The challenge for many practices is to provide PCMH care without adequate funding as we wait for value-based programs to become more prevalent.” And that is …

Step 5: Make a bad, mandatory idea too big to fail. “By joining accountable care organizations, PCMHs can leverage the infrastructure and finances of a larger group to help during the transition to a value-based payment system that benefits patients and providers alike.”
There is absolutely NO data that demonstrates that either patients or providers will be in any way benefitted by the PCMH model.

Step 6: See Step 1. Repeat as needed.