It’s A Trap!

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.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  7 comments for “It’s A Trap!

  1. mamadoc
    February 7, 2012 at 7:28 pm

    It’s from Wellpoint and you didn’t know it was a trap?

  2. Susan Hirsch, M.D.
    February 1, 2012 at 10:07 am

    No offense but who is Admiral Ackbar?

  3. David Hartley
    January 28, 2012 at 10:09 am

    I had similar thoughts reading that article. We family doctors are suckers for this kind of stuff. We always think we are above average compared to other docs and that we should win “the game”. But like a crooked casino, insurance companies can subtly change the rules at any time if their margins are threatened. In the end, this is about Wellpoint reducing it’s costs. They are not increasing FP payouts out of altruism. My guess is that in their computer model of this program (which we are not allowed to see) 20% of FPs will make more money, 40% will be about the same and 40% will do worse. But it won’t be their fault if you lose money. It will be your fault because you didn’t document smoking cessation counseling enough in your EMR or you couldn’t convince the guy in room 3 to go on insulin with a HgbA1c of 11%. I recently had my pay quarterly docked $1600 by my hospital employer due to a drop in my “patient satisfaction scores” They sent out about 100 questionnaires to randomly selectees out of 1100 patient visits. They got about 20 back and 8 of them did not give me “top box” for quality (probaly didn’t give them enough of the holy trinity: zpack, xanax and vicodin). How can you expect to win this game if you don’t know the odds?

    • Doug Farrago
      January 28, 2012 at 10:38 am

      You are 100% right. I love the “altruism” part. Thanks for commenting.

    • Bridget Reidy MD
      February 3, 2012 at 5:07 pm


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