How I Predicted this New VA Joke


The date was June 15, 2014 and here was my entry:

In almost a parody upon itself, the AAFP News put out this headline for its article on the VA mess:

Family Physicians ‘Stand Ready to Assist’ Nation’s Veterans

In other words, family docs, we are sending the veterans your way. Like it or not. The AAFP offered our services so be a good sport about it and do it. The government will thank you some day. Not.

The AAFP outlined five proposals that could address the immediate primary care physician shortage:

  • Allow family physicians working outside the agency to treat eligible veterans.
  • Permit prescriptions written by civilian family physicians to be filled at VA pharmacies.
  • Allow civilian family physicians to order diagnostic tests at VA facilities.
  • Permit FPs outside the system to make referrals to subspecialists and other health care professionals working in VA facilities.
  • Enable civilian FPs to provide care for eligible veterans in accordance with the protections provided by the Federal Tort Claims Act.

Listen, we all want to help patients. We all feel patriotic to our country and want to help the veterans. I get that. I also get that veterans are not easy patients and have a ton of problems. There also is a NATIONAL primary care shortage for the same reason there is a VA primary care shortage. That reason being MONEY. So before the AMA offered us up so casually they should have asked for some real concessions. More pay. No nurses leading ACOs. More overall tort reform. And a ton of others things. Instead, they threw us under the bus again. Thanks, guys, should be lots of fun.

So why do I bring this up 8 months later?  Well, this is from the AAFP website:

VA Payments for Physicians in New Program Fall Short of Expectations

  • The Veterans Access, Choice and Accountability Act was signed into law in August with the intent of expanding health care access for veterans, but the AAFP is concerned that restrictive payment policies included in the interim final rule implementing provisions of the act could limit physician participation.
  • Currently, the VA contracts with only two third-party administrators (TPAs) to handle the Veterans Choice Program established by the law, and payments these TPAs are offering physicians are much lower than anticipated. The Academy’s letter urges the VA to at least meet Medicare rates.
  • “Many family physicians are reporting that these TPAs, if they’ve even yet bothered to approach the practice about participating in the Veterans Choice Program, are then offering reimbursement rates that are 30 percent less than the Medicare physician payment rate,” the AAFP letter reads.
  • Finally, under current rules, physician practices participating in the Veterans Choice Program are prohibited from collecting co-payments from veterans at the time of service. Practices can bill patients only after the VA processes claims, a policy the AAFP opposes.

When will the AAFP ever learn?  They offered up our services and got bitch slapped again.  It’s laughable. And I called it from the beginning.

That being said, I will see any Veteran that comes my way.  I won’t even bill the government.   It just costs him or her $75 a month. That solves this whole mess.

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] 

  2 comments for “How I Predicted this New VA Joke

  1. Pat
    February 28, 2015 at 8:37 am

    Doug, I presume there are no present laws preventing you from direct billing a VA patient? A few years ago a cash-only friend of mine looked at the 3-page document every Medicare patient had to sign before he could see them, and decided it wasn’t worth the risk. Do you anticipate the government trying to prevent vets from seeing DPC docs?

    • Doug Farrago
      February 28, 2015 at 10:54 am

      I have every patient sign the same document that tells them I have opted out. Takes 3 min. And then I can bill them what I want. 🙂


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