Fixing Frequent Flyers

Did you know that about 90% of the cost of hospital and ED care is spent on 20% of the patients?  So, how do we fix the “frequent flyer” problem?  This article was sent to me by a long time reader.  It describes how “Dr. Jeffrey Brenner is spearheading an innovative approach to primary care, using health data to identify hospital frequent flyers and deploying teams of nurses and health coaches to get patients’ health – and health care costs – under control.”   Interesting, I had the same kind of idea myself so I was actually excited to see this.  Here were my thoughts in this blog entry called Super Utilizers.  In that piece I recommended:
  • Buying a small building or park a nice trailer next to the ER.  
  • Get a few family docs and pay them a ton and I mean a ton (these are the toughest patients in the world).
  • Give them adequate staff to call these patients, visit these patients, etc.  
  • Lastly, pay each of these patients $50 to show up to their regular visits.
  • Sorry, and one more thing, remove the EMTALA law for these patients and have a staff member (runner) literally walk them over from the ER to this new clinic when they show up.  
  • The hospital and government would save millions of dollars each year.
I thought that was a pretty good concept, didn’t you?  What does the great Dr. Brenner want to do?
  • Dr. Brenner said that in an ideal primary care practice, RNs would handle the well-child visits, the sore throats, and the simple medication adjustments.
  • We need to industrialize primary care so that it becomes highly reliable, it becomes protocolized, standardized, and delegated so that we can stand out on a limb and customize and individualize for the sickest and most challenging patients,” Dr. Brenner said
  • He wants to see nurses and project managers given the chance to run clinical care teams.
  • The coalition also relies heavily on Americorps volunteers.
  • “It’s time we got out of the way and let our nurse colleagues get into the game,” Dr. Brenner said. “I think their training is much better suited, frankly, for running teams, for working collaboratively, and for really improving quality and reducing costs.”

As you can see, Dr. Brenner and I do not have the same plan.  Trust me, I want to delegate the time wasting stuff too but I define that as clerical work and computer entry not CLINICAL CARE!  He wants to dilute healthcare by having lesser educated and lesser trained people deliver it.  He wholeheartedly supports INDUSTRIALIZED MEDICINE (mooooo go the cows) versus AUTHENTIC MEDICINE. I fight every day against the concept of industrialized medicine and will continue that battle forever.

Why does Dr. Brenner think this way?  I don’t know.   The article says he couldn’t make it when he had his own office:
Dr. Brenner said that he knows firsthand what’s like to try to do it all – that was his approach in his own practice. He had a completely paperless office and open-access scheduling, but he tried to make everything work by simply working harder. Ultimately, declining reimbursement from payers made it impossible to keep the doors open.
The guy couldn’t handle it in his own practice but he has a way to industrialize medicine for everyone else?  I give this guy some credit.  His heart is in the right place but that doesn’t make him right.   No where does he give any type of incentive for a family doctor to work with his coalition.  All he does is jump on the bandwagon to try and get lesser qualified people to give care in order NOT to pay his colleagues (primary care is the lowest on the totem pole for pay).  And somehow family docs are going to join and let Americorps volunteers treat these patients while the docs get paid little or nothing for supervising them and take on all the liability?  What does that get?  I will tell you what it gets.  It gets Dr. Brenner a MacArthur Foundation award, which is a “no strings attached” stipend of $625,000 to be paid out over 5 years.  Why?  Because these groups and the media support any idea or method to take the power out of the doctors hands.
As for me?  I get nothing.  Not even a free pen from a drug company anymore.

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] 


  4 comments for “Fixing Frequent Flyers

  1. mamadoc
    November 6, 2013 at 8:41 pm

    Read this guy’s “plan” elsewhere and concluded that he is another traveler from the planet Wacko where they dream up all this nonsense. We’ve already seen what “getting out of our nursing ‘colleagues’ way” has led to, and it ain’t good. And as Dr. Morrow says, patients want their doctor to be in charge, not a nurse, and I doubt they’re especially interested in pharmacists for that role either.

  2. Madelyn Sieraski
    November 6, 2013 at 1:43 pm

    Now the physicians can take care of 4 or 5,000 patients instead of 2,000. That should make their life easier. All day and into the evening we can sit in front of the computer trying to figure out what was done and why for each patient. At least with medical students and residents you can re-examine the patient.

  3. Mary Helen Morrow, MD
    November 6, 2013 at 8:56 am

    Maybe this guy is married to someone that works at a community health center….or maybe he does now. Serious Kool-aid consumption going on. I will tell you that paitents do NOT want nurses or anyone else coordinating their care. Helping-yes. Teaching – yes. but in charge they want their DOCTOR.

    Three years ago, after trying every care model in the area, I finally left all insurance behind and have a cash-only practice. It took a while to build up, but I have TIME to take care of my patients. I don’t have to move them through like cattle. I have minimal staff because we are not fighting with insurance companies (as much…lately we are fighting prior authoriz. for drugs and procedures).

    And I do work WITH my local pharmacists and WILL see drug reps…..but only prescribe if it is truly to the benefit of my patient (medically AND financially). This is what medicine is supposed to be about. If I am legislated to take Medicare or “made” to practice “industrialized” medicine, then I will be finding a new country!!!!!

  4. Ellen Luse, RPh
    November 6, 2013 at 8:03 am


    That was our great congretional folks that decided we couldn’t get pens and pads from the drug companies! I think they went to far, but I do have to say that, after having been Director of Pharmacy in two small (80 beds) hospitals, we could tell when drug reps had been to town as all the orders were changed to that rep’s drugs!

    Why not work with pharmacists to monitor important drugs for patients? We are trained to do that and do it well!

    I keep he stating to say it, but the truth of the matter is that we are better trained than FNPs and PAs to assist physicians in a lot of ways. Talk to your nearest pharmacy school Dean and find out what our curriculum is. Most of our textbooks are the same as yours.

    Getting off my soapbox now,

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