CPC+?
I always like to point out the nonsense that goes on in our healthcare system. Primary care, which really is a very simple concept to understand, has been picked apart, blown up, quantified and destroyed by the idiots in charge. The only thing they haven’t truly embraced is the thing that works the best, that being direct primary care. Instead they have another hoop called CPC+. What is it?
- a joint Medicare-commercial insurance medical home venture that’ll be available in as many as 20 soon-to-be-announced regions.
- The five-year Comprehensive Primary Care Plus (CPC+) will accept 5,000 practices, half in a basic track and half in a more advanced track. Both tracks offer care management fees and performance payments to reward practices for quality improvement and cost reductions but they’re more generous in the advanced track.
Yup, more of the same unproven concepts that got us where we are today. But at least they gave it a new name, right?
One of the fundamental tenets of primary care is that it does not scale. If you are manufacturing widgets, it is cheaper and better to have a large widget factory than a small widget factory. Primary care does not work the same when expanded into huge operations. The “village model” provides entirely different and far superior care to the industrial model.
And the village model cannot be faked, by CBC+ or other artificial Potemkin practice tricks. Having the “opportunity” to deal with patients on-line, I note that their “questions” are often – “Send me a Z-pak!” and their feedback ratings state that the doctor did not address their complaints nor solve their problem. Ooo, spank me harder, Press Gainey!
The “players” in medicine have evolved into megalithic corporations which, sadly, seem to take their playbook entirely from some Marxist manga cartoon of the wicked capitalist who finds that cruelty profits and abuse sells. If caring for people is the incremental cost of doing business, then one should stomp out any sign of good care.
Not only is that mean; it is nonproductive.
The Big Entities – businesses, institutions, government – need to reap the 5% profit they intended to make on “economy of scale” and “improved efficiency.” It is phony logic. They desperately need to improve “primary home care” so that they can ride its cash flow for survival. It ain’t there.
I predict that within four years, “Healthcare is a National Security Issue!” and that medical licensure will be subsumed under some rickety confabulation of the Public Health Service and a HHS/DHS joint measure that will make CMS look like a performance of art and grace. “Lieutenant-Doctor, here is your medical license, and you will be posted to northern Nevada.”
The Little Minds of Big Institutions have only a smattering of stale ideas, most of which have proven threadbare for decades, but are always at hand. It will get worse, and DPC will be threatened. The one idea that all government fears is “leave the people alone, and they will fix it on their own.”