Beware of Advocacy Groups Bearing Specialists by Pat Conrad MD


A-freakin’-Ha! After burying the headline “Direct Primary Care Promises to Ease Paperwork” on page 31 (Family Practice News put other obvious choices about opioids and heart failure on the front page), I wondered whether organized Family Practice was willing to stop the auto-colonoscopy. Nope.

In the first paragraph, author Shefali Luthra tells us DPC “has been considered health care for billionaires”. Really?? She does not cite the source for such an idiotic phrase, nor does a writer on economics explain how a rising industry could be sustained off of such a (obviously) small population. We supporters of independent medicine unencumbered by Big Government and Big Insurance should be thrilled by recognition of DPC, right? Not so fast.

The author cites a lobbyist for the Direct Primary Care Coalition, and cites the AAFP estimate that 2% of its membership offer DPC. She cites the AAFP president, Dr. W. Filer: “I hear a lot more interest.”

Then comes the role call of do-gooders, and the corruption radar snaps on:

  • Dr. Robert Berenson of the Urban Institute: “Can people afford this?” “Berenson pointed out that partnering with insurance or public programs is key to making DPC affordable for lower-income people.”
  • The American College of Physicians, advising doctors to recognize how DPC could affect “poorer” patients.
  • Dr. Ann Hwang of the Center for Consumer Engagement in Health Innovation: “This is so new that I think the jury is still really out on whether this will be successful.”
  • A Seattle company named Qliance is testing how to blend DPC with Medicaid, promising enrollees the unlimited visits and virtual access of the direct model. Qliance has a contract with Centene, the company running Washington state Medicaid, and promises that enrollees who need specialist care will be referred to one that accepts Medicaid. Qliance is trumpeting “personalized” care for government patients as “a breath of fresh air,” but then shunting them off to Medicaid-accepting providers. So your access is “unlimited” – until it isn’t. Oh yeah, I almost forgot – Medicaid negotiates the monthly payment rate. Do any of us really believe that they will forgo the ability to review records, check for accurate coding, quality, core measures, and all of the other garbage that has most of us wanting to find other work? Similar initiatives are underway for Medicare Advantage, which we can bet will come with similar strings.
  • A similar initiative is starting up in New Jersey: “The monthly fee is undetermined.” “That’s appealing,” said Mark Blum of America’s Agenda, another of the ubiquitous advocacy groups. “There are a lot of eyes on New Jersey right now.”

Now Ms. Luthra really gives it away: “Despite its potential, the direct primary care model faces the challenges of integration into existing payment systems…” The ever-loving point of DPC is to completely divorce existing payment systems, trash them, deep-six, set them afire, throw them in the river, and otherwise have no involvement with them, not integrate!!

The author belies a larger systemic prejudice against DPC in the guise of a balanced article. The AAFP will continue to indirectly oppose DPC, as will the AMA, ACP, CMS, Big Insurance, and every bleeding heart, worthless consumer advocacy and do-gooder group able to cash a charitable contribution check. I have learned over two careers and a few decades that big government corrupts everything it touches, and that goes double for medicine; blending Medicaid with DPC is simply, obviously a way to undo DPC while keeping the name. Offering access to specialists that sign on to these hybrid programs is also another way to diffuse, dissipate, and undo the actual value of DPC. The more that DPC grows, the more we will hear the cries of class warfare – “it’s unaffordable!” – and see a growing threat of government force to shut it all down.