A recent WSJ article had an enticing header. It said “An Rx? Pay More to Family Doctors”. It sounded so alluring. My pulse quickening as I started to read but then I realized it was a trap. Where is Admiral Ackbar when you need him?
The article starts out with how Wellpoint (an insurance company) will offer primary care doctors a fee increase of around 10%. That sounded nice. Their “approach” could pour an additional $1 billion into primary. Wow! That would be great. But then they started mentioning the qualifiers: meeting certain standards, developing treatment plans for chronic diseases, paring the overall cost of their patients’ care and so on and so on. The WSJ article was a commercial for pay-for-performance! What other specialty in medicine has to go through these tricks like primary care? Why can’t they pay us more because we deserve it, the country needs more of us and this may entice more medical students to become family doctors or internists?
Let’s look at some of crap that is just mentioned in this article:
- Some form of 24 hour access
- Keeping a registry to monitor chronic disease care
- These programs only include those doctors who meet certain quality goals
- Only practices certified as “patient centered medical homes” will get the payments
- Providing longer hours of access
- Reminding patients when they are due for tests
- Coordinating care with specialists
I do most of this for my patients now as it is. I may not do it the way each insurer wants me to, however. Trying to please all these idiots may not be possible or affordable. Even though a Harvard researcher in the article states, “we have no strong evidence of cost savings yet” the insurance companies have their own data to support this. Yeah, where is it? How about data proving that P4P programs truly improve patient outcomes?
I for one would like better systems to allow us to do a better job with our patients. The problem with the insurers getting involved, however, is that you just know they will be looking for a way to screw us in the end. Sure it is a 10% bonus now but later many doctors will be penalized 10%. And since each insurer has different standards of what “access” is or “chronic care monitoring” is then you have more and more confusion.
No, we are heading in the wrong direction. This is bad for patients. This is bad for family doctors. Admiral Ackbar was right all along.