Living On Tulsa Time by Pat Conrad MD


“I was goin’ on to Arizona, maybe on to California

Where the people all live so fine

My momma says I’m crazy, my baby called me lazy

But I’m gonna to show ’em all this time

‘Cause you know I ain’t no fool an’ I don’t need no more damn schoolin’

I was born to just walk the line”

“Tulsa Time”, originally performed by Don Williams
(You can catch Don singing our title track in a honky tonk in “Smokey & the Bandit, Part II”, but I prefer the bluesier Eric Clapton version.)
Who doesn’t love caring for the Medicare crowd, huh? A complicated, demanding, entitled bunch with dining rooms full of family members ready to sue your ass off, for whose care you will be paid bare overhead sounds just like a recipe for professional happiness to me. So write in and tell me how ungrateful, and how heartless I am, and yada yada yea…I don’t care. What I KNOW is that LBJ was a brilliant if unprincipled and ruthless politician who devised a way to put his party in power for eternity, and pulled it off by pulling on the heartstrings of the compassionate-by-proxy in an affluent post-war society. What I KNOW is that Medicare is a financial disaster that was actuarially out of balance by 1972, and that it is a metastatic process that has corrupted all of medicine and put the entire nation on the path to economic collapse. Other than that, it’s great.

It’s so great that the Centers for Medicare & Medicaid Services keep coming up with jack-in-the-box farces to prop up their rotting organization, and telling self-abusing doc’s that everything is getting better. Modern Healthcare Magazine tells us, “The CMS Innovation Center (I know, I know…) says the 483 medical practices participating in its Comprehensive Primary Care initiative achieved $24 million in gross Medicare savings, but few saved more than what the government paid them to coordinate patients’ care.” That intro line is funny on its face. $24 million is the dribbling of subclinical urinary incontinence compared to the flood of Medicare spending ($505 Billion in 2014). So the CPC saved – drum roll, please – 0.005%, if I round up. This stupid don’t-look-behind-the-curtain program was featured in seven regions coast to coast. The only successful outing was in “The Greater Tulsa, Okla., region …where the savings exceeded what Medicare paid them in care-management fees.” The savings was $10.8 million, or 0.0002 %.



There is some happy boilerplate about “encouraging signals that the fees are helping physicians improve care coordination. Readmission rates in all of the program’s geographic areas were lower … more than 90% of the practices met quality benchmarks for patient experience…primary-care practitioners (scored) particularly well on communication and timely access to care…”

Dr. Patrick Conway, CMS deputy drone and chief medical officer said: “These CPC initiative improvements came earlier than expected in a model involving significant changes in the delivery of primary care.” He described these as “promising results of the first shared savings performance year for the Comprehensive Primary Care (CPC) initiative.” Conway gleefully added that, “Over 90 percent of CPC practices successfully met quality targets on patient experience (as determined by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys) [which proves NOTHING] and utilization (hospital admission and readmission) measures, indicating quality scores that matched or exceeded national comparisons [which, again, proves NOTHING].”

Commissar Conway further elucidated that “Advanced primary care is the foundation of a high-performing health system…primary care practices act as the quarterback of the health care team. CPC practices help patients navigate their care, communicate with specialists and hospitals, and ensure that patients with complex social and medical needs do not “fall through the cracks” of the health care system.” And we’ll pay you – maybe – enough to cover your additional costs of meeting all the reporting requirements. And when you wake up the next morning in a ditch next to the roadhouse, dirt in your mouth and dried blood in your nose, hung over on really cheap liquor, and a Medicare audit looming…

Conway says the Tulsa regional victory was “500,000 in shared savings payments.” So almost 5% of the actual savings went to the people doing the damn work. Sign me up…
“Then I started thinkin’ man, and then I started sinkin’

And I really had a flash this time

Oh, I had no business leavin’ and nobody would be grievin’

If I went on back to Tulsa time.”

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] 

  5 comments for “Living On Tulsa Time by Pat Conrad MD

  1. gene
    October 28, 2015 at 9:44 pm

    Stop accepting insurance as payment in your practice. Then there will be more than enough primary care physicians to go around. The current paradigm is designed to put you out of business.

  2. Ben Van Raalte
    October 26, 2015 at 10:28 am

    Where prople paid $20 a YEAR in 1971 in payroll deductions that somehow magically covers $20,000 a year or more in coverage in their old age. Somehow it covers A DOZEN stents, two knee replacements, a 200,000 chemo treatment to live 6 more months, and they areliving 15 years longer than they paid benefits to cover, at old levels of treatment. The national debt of 18 trillion is equal to the underpayment of benefits for ss and Medicare by those born 1926 to 1945, the greed generation.

  3. RSW
    October 26, 2015 at 8:07 am

    As always, the math is fishy.

    377,000 Medicare patients, 24 million in savings = about $60 saved per patient.

    Medicare paid $240/patient/year in management fees.

    I guess they’ll make it up on volume.

  4. Perry
    October 26, 2015 at 7:05 am
    • Seneca
      October 26, 2015 at 8:17 am

      Even though the emperor has no clothes, the AAFP continues to swallow every acronym ejaculated by CMS.

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