Out of the Labyrinth

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Here is a nice article that explains what I believe is the ONLY way out of the labyrinth we call healthcare.  It is the only thing that removes the shackles put on us by our employers.  It describes direct primary care really nicely and paints a great picture.  Then the idiots get involved at the end of the article and they try to ruin the whole thing. I recommend you read it but here are the “concerns” given by these health policy experts:

  • Low-income patients without employer-provided health insurance may gravitate toward direct primary care because the monthly fee is cheaper than a health insurance premium, and they may not realize that they also need catastrophic health care coverage. Physicians who operate direct primary care practices are ethically obligated not to accept patients who don’t have at least catastrophic health care coverage.
  • Americans with high-deductible plans can’t use their health savings accounts to pay direct primary care fees. An advocacy group, the Direct Primary Care Coalition, is lobbying for changes to the U.S. tax code to expand the scope of HSAs.
  • Engelhard is also concerned about care coordination and physician accountability under direct primary care. She argues that physicians who opt out of the fee-for-service system become isolated from their peers and cannot participate in government initiatives designed to improve health care quality and efficiency, such as the patient-centered medical home.
  • “Direct primary care increases health care fragmentation,” Engelhard contends. Though the individual physician may reduce his or her overhead, the model does not reduce health system costs, she says.

So her are my responses:

  • Ethically obligated not to accept patients who don’t have insurance?  This forces them into a fragmented pattern of ER or urgent care system.
  • Can’t use an HSA card?  Who says?  Many states have passed their own laws stating this is fine and the IRS has never audited and rejected using an HSA card for direct primary care.
  • Can’t participate in government initiatives that are designed to improve quality and efficiency?  The present systems does neither and this is one of reasons I left.
  • Increases fragmentation?  Does not reduce health care costs?  The former is unproven.  The latter has been proven that we do.

It seems to me the ivory tower idiots are getting scared.  We have them on the ropes, people.  Time for a knockout.

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 “Out of the Labyrinth

  1. Bridget Reidy MD
    May 15, 2015 at 2:51 am

    Last I heard they were taking the phrase,”patient centered” out of medical home. Here in Canada bureaucrats are trying to make more jobs for themselves with ideas like this borrowed from the States, but not telling people where they came from because everyone knows the US healthcare system is a disaster. And they didn’t even change the name even though all Canadians already think their (usually) independent GP or FP is their medical home if they are lucky enough to have one.

  2. Ken
    May 11, 2015 at 10:08 am

    Doug, can you give an update on your direct primary care experience? How is your panel size?
    Do you have a partner yet? Anything unexpected pop up?

    • Doug Farrago
      May 11, 2015 at 12:11 pm

      I am half way to 600 but may have a college insurgence soon. That is in 6 m and starting from scratch. No partner….yet. Overall, it is awesome.

  3. Perry
    May 11, 2015 at 10:00 am

    I have several comments:
    First, this concept of “patient-centered” practice is a joke. It was probably dreamed up by some policy-maker types. You can’t have medical care without a patient, and I don’t hear plumbers saying they’re “pipe-centered” or accountants claiming to be “tax-centered”. The way docs are being forced to practice is anything but patient centered, payment centered, computer centered, documentation centered, but not patient centered.
    Secondly, who wants to participate in the time, energy-wasting “quality measures” that just take docs away from patient care?
    HSAs should be examined as a cost-saving measure, allowing patients to put away some money, yet be cost-conscious of their care. It’s absurd the gov’t wouldn’t want people to participate in that way.
    The gov’t persists on putting more layers between patients and providers, and how is this going to cement relationships and enable quality care and collaboration between the two parties?

    Going back to your previous post, it’s time for us to say, F*** You!

  4. Bill Ameen MD
    May 11, 2015 at 8:35 am

    Translate “physician accountability” as “physician control”. One of my colleagues made a good point that the way the government will eventually “corral” independent physicians is through federalization of licensure…as in Massachusetts, which I believe links licensure to board certification. They’ll find a way to f*** us.

    • Pat
      May 11, 2015 at 9:10 am

      Bill, I’ve been predicting that for the last decade. It will follow the model the Reagan administration use to force the states to adopt a universal drinking age of 21 in 1984. DPC represents a very real threat to collectivization, which these bastards will have to snuff out.

    • Steve O'
      May 12, 2015 at 12:46 am

      Our state was toying with a “15% minimum” Medicaid obligation for all practitioners. Fortunately, that got stopped, but no idea in government goes extinct from its own stupidity – government is a Jurassic Park of bad ideas that never were allowed to go belly-up.
      Imagine that – “Sorry, Mrs. Beasley, I won’t be able to see you for your heart failure until I get another two Medicaid patients in. Otherwise I’m out-of-balance and could be fined.”

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