It’s So Simple!

This is your new payment plan:

The CMS’ Comprehensive Primary Care Plus program offers three forms of upfront financial incentives to health care practices that offer comprehensive care management while implementing payment reforms. These incentives include care management fees that are based on the patient’s risk score and on the payer, performance-based incentive payments which are given as rewards to a practice’s performance on quality and utilization measures, and Comprehensive Primary Care Payments that are only given to practices participating in Track 2 of the program.

The above summary came via the AAFP Family Medicine SmartBrief but the full article is here in Medical Economics.  Doesn’t is sound great?  Do you understand any of it?  I don’t. Let’s count the big words/terms that mean nothing:

  1. Comprehensive
  2. Incentives
  3. Reforms
  4. Care management
  5. Risk score
  6. Performance-based
  7. Quality and utilization measures

Wow, nice job!  There are seven “administralian” words/terms (use language of administrators).  My bullsh%t detector goes off when there are more than 2 administralian words.  Therefore, the odds of this plan working are minimal.

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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] 

  9 comments for “It’s So Simple!

  1. Kurt
    July 13, 2017 at 2:02 pm

    Whadd’ya talking about Doug. Tain’t ever going to work if patients are allowed to continue
    their lousy health habits. Can try to educate them all you want, if they don’t “got” no skin in the
    game, they don’t care. I be “edjucat’in” patients for years and very few change. I’m glad I will
    be out of this system (hopefully retired) before the poop really hits the fan and the Ivory Tower Boys are left wonder’in why this isn’t working. Don’t pay us, pay the patients, incentivise them
    not us, ’cause it ain’t working when we do it anyways! Hasn’t worked for the 29 years I’ve been at it. I spent most of my time picking up the pieces all the way to closing of the casket lid.
    Oh, I still think anyone who dupes a poor med student into going into FP should be cast into Gehenna for eternity for leading a lamb to slaughter. I base this on the number of physicians much, much younger than myself who now despise their choice of specialty.

  2. Randy
    July 11, 2017 at 10:48 am

    If you read the article, it notes that the great majority of eligible practices didn’t participate because of the administrative and reporting burdens.

    Anyway this is the part of the article that struck me:

    ” For example, Ward estimates that a practice enrolled in Track 2 of CPC+ with about 500 Medicare beneficiaries would get roughly $200,000 in additional payments a year from the program’s incentives. This is separate from the 5% MACRA bonus.

    “If you had $200,000 each year for five years, that can be a nurse, a medical assistant and a social worker,” Ward says. “The nurse could do your care coordination, the medical assistant can assist you either in the office or can do outreach. And the social worker can do your integrated behavioral health.”

    CPC+ is a complex program with numerous rules, regulations and reporting requirements. The quality measures are ambitious, says Ward.”

    So he’s saying use that 200K to hire more employees, well you see what is missing there. I’m a solo FP and more empoyees mean more work for me, hiring, training, figuring out what to do if somebody leaves, overseeing the program, etc. If I’m going to do that work then I want to be paid for it.

    Add to that his last statement about the numerous rules, regulations and reporting requirements. That means if I don’t do everything right I lose even if I’ve put in a bunch of work. I fell for this once with Meaningful Use and don’t want to go through it again. This just looks like once again putting docs in a position to fail by a bunch of administrators who know little about practicing medicine.

    • RSW
      July 11, 2017 at 11:03 am

      It’s AAFP Math for Morons:

      Generally, medical home projects like this cost about 100K/provider/year, which as always assumes that the doctor’s time is free. Add in three new employees and subtract all that from 200K and you get . . .

      I guess you make it up on volume.

      • Randy
        July 11, 2017 at 12:03 pm

        I remember reading some advice on business that said you only hire employees for one of two reasons – either to make more money or make your life easier. A lot of medical organizations seem to think you hire employees to make more work for yourself and hope to break even.

        • RSW
          July 11, 2017 at 12:32 pm

          We run our practice on the philosophy of “If the AAFP is for it, it must be a very, very bad idea.”

          Never forget that the medical societies are largely run (particularly in the behind-the-scenes permanent executive positions) by docs who were failures at the practice of medicine.

          • Pat
            July 11, 2017 at 10:13 pm

            RSW, that is a very good rule!

  3. Pat
    July 11, 2017 at 9:11 am

    ‘Minimal’? Way to generous. This is a dead joke before it starts.

  4. RSW
    July 11, 2017 at 8:19 am

    Because nothing says logical thinking and good use of resources better than building on and expanding a program (the original CPC) that was a total floperoo:

  5. Seneca
    July 11, 2017 at 7:29 am

    My prediction: two or three big firms or hospital systems will figure out how to scam the system and make (more) millions. The rest of us will be penalized for providing actual medical care, as opposed to industrial scale LELT enabled assembly line medicine.

Comments are closed.