Panelists at the National MACRA MIPS/APM Summit (what a blast that meeting must have been) said alternative payment models included in the Medicare Access and CHIP Reauthorization Act should be revised to include the full range of services provided while accounting for integrated care and data sharing.

The panel discussed reasons why physicians have been slow to adopt the new payment models, noting time limitations and the complexity of the programs.  Here is what was recommended:

  • Physicians need strong office management to handle the new demands of record keeping and performance measurements. Practices that created teams often employ daily “huddles,” but time limitations pose a problem to smaller practices.
  • With new payment models comes the expectation that physicians and hospitals will share data and agree on shared risk with insurers

Integrated care.  Data sharing.  Huddles.  Shared risk.

So, how many of you want to do DPC now? My advice is to leave. Run. The ship is sinking and you are rearranging chairs on the desk of the Titanic.

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] 

  7 comments for “MACRA Stuff

  1. Pat
    December 21, 2016 at 4:51 pm

    Medicine is an inherently dishonest industry (doctors included), which makes it susceptible to scams like MACRA. If I could do it over, I would do an ER residency … or not go into medicine at all. This exploitive self-abuse won’t stop with primary care, but that is the first to avoid and the worst to pursue. Family practice is an excellent discipline for learning medicine, and an almost certainly self-destructive commitment to a dead end. Unless one is intent on doing DPC from the start and can plan their debt structure accordingly, then one is an idiot for going into PriCare.

  2. Kurt
    December 21, 2016 at 2:28 pm

    ….. and if one is a medical student, stay the hell away from primary care whatever you do.
    Expect the ivory tower bastards to treat you as a nursemaid, guardian angel, secretary and
    health policeman.

    I’ve received “loving notes” from insurers that “I’m not in compliance” because patient
    X,Y,Z hasn’t had a colonoscopy, or is on an ace inhibitor or statin. I did some cursory reviews and found these patients absolutely refused the above for a variety of reasons. I’m being held accountable for their crappy decisions.

    Again, if one is a student run, don’t walk away from primary care. No matter what you told the
    Ivory Tower Bastards you’ll love primary care, once you’re in, you’re in………… Unless of course you signed away your life for educational support for primary care, in that case you’re screwed.


  3. RSW
    December 21, 2016 at 10:27 am

    My favorite part was the quote from fake doctor Grace Terrell:

    “In the medical field, integration means addressing physician health, mental health, substance abuse and social determinants”

    Yep, you Doc, are responsible for your patient’s housing, food, transportation, employment, and everything else in their lives.

    These people are f**king nuts.

  4. Perry
    December 21, 2016 at 10:24 am

    According to Medpage today, MACRA ain’t going anywhere fast. Head for the lifeboats folks before they run out!

  5. Randy
    December 21, 2016 at 9:01 am

    Nothing wrong with daily huddles, if you use them right they can improve efficiency. In the context of meeting MACRA criteria and making sure all the little boxes are checked, they will be a time waster.

  6. December 21, 2016 at 7:41 am

    It always amazes me to see all these cadre of (expletive) people without medical training telling us what to do and how to do it. In the end, it was our fault to have lost control of the ship (picture above) that illustrate well the current status of our medical landscape.

  7. Steve O'
    December 21, 2016 at 7:41 am

    The small amount of common sense from a former chair of the AMA is lost in the fog of this conference:

    “A lot of practices don’t have time to stop and think about how they do what they do,” said Barbara McAneny, M.D., former chair of the AMA.

    “All payments hinge on face-to-face meetings,” McAneny said. “Nobody is paying us for the time spent by nurses who are talking all day with patients on the phone. The expense side of the ledger is still on us, and the revenue accrues to the payer.”

    “You’re searching for that one needle in a haystack,” she said about EHRs. “It’s more efficient to pick up the phone and talk to somebody.”

    But the mid of the bureaucrats shall prevail. I can see the NewThink brewing to make “DPC,” or a hellish imitation of it, fit into a corporate-employee model. It’s not what you do, it’s what you call it, the bureaucrats know.

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