$4.90 PMPM


The new per-member, per-month (PMPM) care management fee is starting to get noticed as, well, a big nothing.  As this article states, “That fee is designed to pay physicians for patient care that falls outside of a normal office visit, but the amount varies among payers and is almost universally considered too low by physicians.”  Once again, I must interject the point that most hospitals take this fee and DO NOT give it to their employed physicians.  (If anyone out there has a different story, please give me the details).  Anyway, the article goes on to say that “the AAFP shifted into high gear to address some tough issues related to care management fees” and that is when I was caught between losing interest and laughing uncontrollably.  Anyway, they go on to describe a study called Valuation of Care Management Performed by Primary Care Physicians, which was created for the Academy by Discern Health, a Baltimore-based consulting firm. Authors highlight the benefits of care management and, after conducting an extensive literature review, conclude that the “benefits of care management provided by primary care practices exceeds current payments by insurers.” No sh$t, Sherlock.

So, what is the discordance?:

They calculate the value of care management to insurers in terms of savings as $16.73 PMPM but insurers’ cost in payments to physicians for providing those cost-saving services as just $4.90 PMPM.

$4.90 to $16.73?  Good luck with increasing that.  And I bet there aren’t many hoops and hurdles for the doctors to overcome in order to get that money, huh?

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] 

  3 comments for “$4.90 PMPM

  1. Perry
    August 24, 2016 at 2:47 pm

    “the AAFP shifted into high gear to address some tough issues related to care management fees”

    What you mean from reverse to neutral?

    • RSW
      August 24, 2016 at 3:13 pm

      The language used by AAFP News is hilarious – we’re told how the AAFP fights, storms, forces, seizes, demands, attacks . . . then we read the articles and find that all they’re doing is sending sloppy mash notes to their BFFs Slavitt and Burwell, dotting their “i’s” with hearts.

  2. Steve O'
    August 24, 2016 at 8:32 am

    The care management fee pays the equivalent of 44% of the cost of my local newspaper. The newspaper most useful when wrapping things for trash day. This is the value “for patient care that falls outside of a normal office visit.”
    If I could afford to run an office on Medicare and Medicaid, I have no doubt that the cost of trash pickup – not to mention HIPPA-compliant document shredding – would exceed the entirety of care management.

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