Flat Note by Pat Conrad MD

In the liner notes for the live album “Song Remains the Same”, Led Zeppelin is on their touring plane, watching an old R&B videotape. Band leader Jimmy Page “watched, took a weary slug of Jack Daniels, and began to grin. ‘You know something’, he toasted, ‘No escaping our roots.’” Maybe that’s what we are seeing with the AAFP, who at any rate cannot escape their instincts toward failure, or their affection for “value.”

Here’s the headline: “Community-oriented Primary Care Shows Promise in Value-based Era.” Any student of this site by now had better be able to pick out all that is wrong with this statement. Author Michael Laff (ahem) cheers a “new generation of medical students who want to contribute to improving the health of the public”, and what better way to do that than with “community-oriented primary care (COPC) [which] is again attracting interest as a model of care aimed at improving health outcomes on a population level.”

It seems a 1940’s South African couple named Kark focused on “ethnically diverse” community and acute needs in a model adopted by a 1957 med student who brought it back here. Now we have 8,000 federally qualified health centers. This volume of centers is referred to as “embedded” by Winston Liaw, M.D., M.P.H., medical director for the Robert Graham Center for Policy Studies in Family Medicine and Primary Care; Dr. Liaw’s history notes that in 1984, “Regrettably, in a payment system that incentivizes volume COPC fail to gain widespread traction…” Some volume good, some bad? But as the AAFP has shown us with patient-centered medical homes, substandard economic results are no reason to quit a good idea.

But the author’s true purpose – and that of the toady AAFP – is to lay more groundwork presumption for value-based payments. Now these and assorted geniuses have created a COPC curriculum to badger residents with population health principles and “engage community health needs outside of clinical care office visits.” Hot damn, I’ll bet that’s why YOU went to med school!

“’In the push toward value-based payment, if you improve the health of a community, then that aligns the providers with incentives, and then there is a strong incentive to engage in COPC,’ Liaw said.”

And that is the punch line. This is again the AAFP pushing shell game-con bogus “value” payment structures. They are approaching it from the community health angle, hoping to make it sound noble, hoping that it will take just enough hold to force more local independents into getting on board the value train. The AAFP simply cannot refuse an opportunity to make primary care more difficult, or less attractive to the hoards of students they imagine to be beating down the doors. The song remains the same.

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] 

  1 comment for “Flat Note by Pat Conrad MD

  1. Mary
    January 29, 2017 at 8:47 pm

    Just decided to do concierge
    Worked for STAFF model HMO FOR 10 yrs
    Employed by hospital for 10 years until
    They closed the practice because of hospital merger
    Private practice since 2000
    Solo since 2009 doing fairly well until the onset of EHR. It has been downhill since.

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