Open Letter

 From a reader:
I had an idea after listening to the presidential debate last week, and I thought I’d share it with President Obama. I’d like to share it with you also:

October 6, 2012


President Barak Obama

1600 Pennsylvania Ave. NW

Washington, D.C. 20500


     Dear Mr. President,

      In the debate you had Wednesday night with Governor  Romney, you mentioned that doctors should be paid based on “pay-for-performance”, a concept where doctors get paid based on their patient outcomes, rather than the number of procedures they perform.  Thus, as a family doctor, if my patient does not follow my advice, and has a less than ideal outcome, I will get paid less than if the patient has a good outcome. Well, I have a great problem with that.

     Doctors work hard to get their patients to maintain healthy lifestyles and take good care of themselves, but even the best doctor in the world will not be successful in getting every patient to comply with his or her advice. Let’s say a patient smokes, and despite urging from his doctor, the patient continues to smoke, and has complications from it.  Under this scenario, the doctor would be paid less since the patient had an adverse outcome. This would apply to diabetes, obesity, etc. This hardly seems fair or realistic and potentially may lead doctors to avoid caring for non-compliant patients, or, even worse, leaving the medical field. How is the government going to convince young people to become doctors and become primary care specialists such as myself, if you don’t make it appealing to them? We are in desperate need for more primary care docs, not less.

     I believe that if this is going to be your policy towards the medical profession, then you should include yourself and Congress in this reimbursement model. If a congressman’s law he introduced does not pass, then a percentage of his income is lost. Unemployment does not go down, and you, as the leader of our nation, gets paid less, or loses some other perk. Please do not be a hypocrite and exclude yourself and other elected officials from this concept. Show some leadership! It is the only right thing to do if you expect others to accept this system of payment. I trust you will do the right thing for yourself, and likewise encourage the Congress to do the same.

     Thank you.

Stephen Behnke, M.D.

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] 

  6 comments for “Open Letter

  1. big picture doc
    October 18, 2012 at 1:23 pm

    I agree with pay for performance for congress, the president, and yes the supreme court, but if you vote for Romney, things will get much worse. See discussion above regarding how Republicans let insurance companies do whatever they want. Now I would also have to agree that Obama has not pushed back on them as hard as I would like, but it’s a matter of choosing the lesser evil.

    • Doug Farrago
      October 18, 2012 at 1:43 pm

      Are you kidding me? Obama’s plan was for an increase in Medicaid patients. Problem is that no one will see them because they pay pennies on the dollar. He had no plan to get students to go into primary care. Why? He is killing the specialty to give it to the NP/PAs. He had no tort reform plan. And please don’t talk about P4P. It is all over the ACA/Obamacare. All unproven!! I will blog soon about the NEJM study showing how the hospital infxn rate never changed using P4P. His whole plan is based on bullshit quality. UNPROVEN. I hate insurance companies but big gov’t is no better. Want a socialized healthcare system? I just saw an 18 yr old with a bug bite an hour before? Earlier I saw a girl with a cold since that morning? Who will see these people x 100000000000 once they get everything for free? Progressives, my ass.

  2. Beth
    October 18, 2012 at 10:13 am

    Dr. Behnke nailed it. No self-serving politician will place any of the onus for wellness on his/her voting constituents, so the risk is all on the provider side (and can’t you just hear the insurance companies jumping for joy as they embrace this new model where their payments are fixed, regardless of cost!). Thus the Feds are back-dooring the country into the same outcome — physicians will not accept non-compliant patients into their practices, so those most in need will get their care in the most expensive venue — the emergency departments of our hospitals.
    Employers may be able to help; they need to keep health care expenses down, and can impose meaningful financial incentives or penalties on employees to promote active responsibility for health and wellness by each employee……..but then here will come that lawsuit alleging discrimination against smokers, drinkers, the overweight, etc. etc.

    In this country we want our cake, literally, and to eat it too. Something has to give.


  3. Melinda
    October 17, 2012 at 10:02 pm

    That letter needs to be actually sent, and also copied to the media!

    • Stephen Behnke
      October 17, 2012 at 11:16 pm

      I sent the letter to the President (actually e-mailed,that is what they prefer) on 10/6, but no reply yet. I sent it to the Chicago Sun-Times, which has printed my letters in the past, but response from then either.

  4. tom walsh
    October 17, 2012 at 9:08 am

    If Pay for performance became the norm for Congress I would imagine that all members of The House of Reps, the Senate, the Vice president and the President would owe money rather than collect a paycheck. I would also base their staffs’ salaries and all the perks on the performance of the Rep or Sen. Now there is a concept I could support. Good way to reduce the deficit, too. Great idea Dr Behnke.

Comments are closed.