Insurer CEO At It Again

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A couple of years ago I wrote about this dude from CareFirst BlueCross BlueShield (can their name getting any longer?). At that time they wanted to give discounts to their customers who choose efficient doctors. Using data collected as part of its “successful” Patient-Centered Medical Home program, they were going to slow the rising health care costs by forcing their customers to these self-defined efficient doctors.  In other words, it co-opted the PCMH machine and used it as a trojan horse to pick the doctors they wanted.  Of course, the AAFP was no where to be found on this and never fought back.   Flash forward and we have this same dude back in action. Chet Burrell, president and CEO of BlueCross Blue Shield, told the AAFP Board of Directors that they are now offering a plan that includes financial incentives to primary care physicians, but does not include penalties.  Really?  Smell’s fishy.  What’s the catch?  Well, here is what he wants:

  • CareFirst asks primary care physicians in the program to form into groups of five to 15 physicians called “panels.” Smaller groups do not produce enough data and larger ones make collaboration too difficult, Burrell said. Most panels have about nine physicians. Panels are graded using a combination of engagement, patient access and appropriate use of services. The engagement score, which carries the most weight, includes patient satisfaction and working within the medical home model.
  • Physicians in each panel hold monthly meetings to discuss the group’s performance and compare notes. CareFirst will not drop a physician from a panel for low performance — only in extreme cases where they refuse to cooperate with the plan — but it will allow the panel members to address struggling practices. Given the competitive nature of physicians, Burrell said, panels motivate each practice to maintain high standards and correct any substandard performance.
  • CareFirst created a “patient care account” that acts as a scorecard for each patient’s activity and related costs, but it is not a substitute for an electronic health record system. To help physicians with referrals, hospitals and area specialists are assigned a grade based on their cost.

Sounds awesome, right?  Burrell told the group that the average practice in the program received an additional $41,000 in revenue in addition to the participation fee.  So, for all that work each doctor gets what?  The practice got $41K but that doesn’t mean the doctor gets anything.  If you are employed by a hospital they will steal that check.  I know because I have seen of my prior hospital employers do to it to our practice.  Even if the doctors got the check, that is $41k divided by nine with is about $4500 per doc.  Does this really sound worth it?   Sounds to me that the penalty is that they would stealing hours from my life to do worthless crap.  No response in the article about how the AAFP board responded but dollars to donuts they lapped it up.  A victory for PCMH once again!!

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 “Insurer CEO At It Again

  1. Steve
    March 8, 2016 at 8:13 pm

    Okay, I have a confession. We are in one of these programs.

    I am in a practice with one other doctor. We are both Internal Medicine and have been practicing in some form together for the past 21 years. For a while, we were with a big multispecialty group and then broke off to become a small practice. We are the owners of the practice. We use a billing company and try to keep it simple.

    As two doctors doing a lot of complicated medical care, more then 60% geriatric related, we are hopelessly intertwined with the insurance companies. We pick and choose who we join, but we do ultimately join insurances which behave with relative reason.

    The main Blue Cross in our area approached a number of practices with this idea of management panels. Our practice decided it was risk free and might give us some experience in assessing quality. It would also give us some exposure to what is being defined as “quality.”

    We have been in this special program for about six months. The extra pay has been surprisingly generous and the work requirements have been rather trivial: About two hours per month. One hour of that is spent in a computer conference call.

    The time has been relatively well spent. We’ve learned a lot of interesting things. The nurses running the program are very nice and easy to work with.

    Based on the feedback, our practice seems to be doing a really good job of tracking and providing care.

    On the negative side, we are grouped in a “panel” of other docs. Unfortunately, a lot of our panel doctors are not doing so well.

    When the suggestion was made for us to interact with the lesser performing docs, we learned some interesting news: The majority of our panel is based in a town 200 miles away.

    Not much interacting possible. Oops….

    Despite this, we are actually enjoying the process and learning some stuff we can do to make the system a bit more efficient.

    How long will this last? Where is it all going? My gut feeling is the program will be gone in six to twelve months as the money runs out.

    So far, though, this is relatively pain free and a bit educational. The money is very generous for the effort involved.

    That’s all I can say.

  2. RSW
    March 8, 2016 at 9:20 am

    41k per practice might come close to covering most of the increased overhead that programs like this demand – assuming, as usual, that the countless hours the docs put in are “free.”

    At least Mr. Burrell has the common sense to admit that “no physician in his right mind ought to take insurance risk,” which makes him about 1000% smarter than the morons at the AAFP.

    Here’s the best explanation I’ve seen of the “sloppy thinking” that creates and perpetuates ACOs, PCMHs, etc.:

    http://thehealthcareblog.com/blog/2016/03/06/why-we-know-so-little-about-acos-the-managed-care-culture-at-work/

    • Seneca
      March 9, 2016 at 9:01 am

      That link is a great article which all should read. Unfortunately, as long as there is money to spread around (most of it freshly printed by the fed), more layers of such bad thinking will prevail.

  3. Steve O'
    March 8, 2016 at 9:11 am

    “Given the competitive nature of physicians, Burrell said, panels motivate each practice to maintain high standards and correct any substandard performance.”

    Hey, let’s give some credit to some of the great modernizations of the past.

    Reform worked GREAT for China during Mao’s Great Leap Forward, bringing the peasants from primitive farming methods to socialism in the field. It was team-building. It was self-improvement. It worked to help everyone succeed!

    “Private farming was prohibited, and those engaged in it were persecuted and labeled counter-revolutionaries. Restrictions on rural people were enforced through public struggle sessions and social pressure, although people also experienced forced labor.” I’d suggests calling them “snuggle sessions – more friendly.”

    It worked, except not so well…

    “The Great Leap ended in catastrophe, resulting in tens of millions of deaths, (estimated from 18 million to 32.5 or 45 million.) Historian Frank Dikötter asserts that “coercion, terror, and systematic violence were the foundation of the Great Leap Forward” and it “motivated one of the most deadly mass killings of human history.”

    How come people get so RESISTANT to honest attempt to improve things? That’s SO counterrevolutionary! People don’t see that starving to death by the millions has some unanticipated benefits.

    The Great Leap Forward. It sure got rid of the rats in the farmhouse. And insects that thrive on crops, and birds, and other pests. They all got eaten. So did some people – but let’s not get into that.

  4. Soccerdoc
    March 8, 2016 at 7:34 am

    Is that $41k per practice or per panel?

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