More Efficiency


Read this article and see how they recommend isolating your high-risk patients (aka most sick) and spending most of your time on them.  The way the article is written it almost sounds like they have found the Holy Grail to being a doctor.  Isn’t that great?  Here is another hidden gem.  See how there is a reference about Henry Ford right at the top?  You know him.  He’s the guy that created the assembly line and mass production.  Coincidence?  I think not.

So what’s the plan for these assembly line docs? Well, first identify your “highest risk for hospitalization, ER visits and high-cost care, and then pour dedicated practice resources into the care of those patients.”  And the biggest part of that dedication is time.  Your time.  The article describes how running a huge team where you are the wizard behind the curtain may be one way to get these people under control.  It also may be a way to get Medicare to pay you a chronic care-management fee. All you have to do is:

  • Assign each patient to a “resource use category” labeled low, moderate, high or extremely high. Within those four categories are six specific risk levels. When patients are identified as high risk, the level of health care services provided to them escalates.
  • “We put more resources toward those patients, increase the number of support staff around them and give their physicians longer appointment times,” said Clark.
  • Patients assigned risk levels of four, five or six automatically are slotted for 30-minute appointments, double that of lower-risk patients.
  • The next big step is examining practice data for hard evidence that shows risk stratification is improving patient outcomes and lowering costs. Clark is looking forward to bringing a nurse care coordinator onboard to manage the highest-risk patients.

I have made claims that we are in an era of industrialized medicine.  This proves it. Remember the Pareto Principle and see how this is similar.  The goal is to spend 80% of your time on toughest 20% at the EXPENSE of your other 80% of patients.  Who takes care of the other 80%? Why do they have to lose out just because they are not sick enough yet?  And we wonder why patients complain that their doctors don’t spend enough time with them.

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] 

  3 comments for “More Efficiency

  1. November 8, 2014 at 3:42 pm

    We need not over-read this article.

    Cost-shifting from wasteful, unnecessary in-patient Emergency Room and Hospital Admissions towards higher quality out-patient care provides the money needed to improve care for our sickest patients.

    Describing the illness of our patients more accurately, annoying and painful as it is, can be used to justify receiving higher payments for these harder patients as we continue reforming health care.

    Spending 80% of our time and money well on our toughest 20% of patients pays off for everyone in the end. Our healthiest patients need us the least anyways. As has been said, ‘Health is harder for some.’

    Stefan Topolski
    country doctor
    Shelburne Falls, Massachusetts

  2. Melinda
    November 8, 2014 at 1:53 pm

    Petty point but pet peeve–Henry Ford did not invent the assembly line–he invented the first MOVING assembly line. The assembly line was invented by Col. Albert Pope, maker of Colombia bicycles, the first high-wheel bicycles made in America, in Hartford, Connecticut. Pope happened to have an employee named Henry Ford….

    • Sir Lance-a-lot
      November 8, 2014 at 3:23 pm

      Well… Technically, Ransom E Olds had the first automotive assembly line, though his wasn’t continuously moving, several other industries producing smaller, simpler items, had moving assembly lines decades before, and the Chicago slaughterhouses used continuously moving “disassembly” lines, also for decades before the Model T.
      Also, Henry Ford didn’t personally invent his own assembly line – He hired a number of bright, creative people who worked by trial and error over several years, and finally created the synchronized moving assembly line as a result.

      Other than that, yes, it is the wet dream of hospital administrators to have us all work on an assembly line: Imagine the efficiency if the patient sat on a table that moved through the practice as one of us got the history, another auscultated the lungs, another palpated the abdomen, etc. You could have the fastest, most accurate lung listeners, belly pokers, info extractors, etc., and just think of how accurate and efficient it would be. Then, once you had developed the individual positions more, you could train non-physicians to perform each task, better than any doctor could, and the doctor could sit in a control room receiving data and writing the Assessment of each note (Subjective and Objective would already be done, and each Assessment would automatically lead to a preprogrammed Plan).

      Think of the money each hospital could save, to go to raises for all of the administrators!

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