So That’s All I’m Worth? by Pat Conrad MD

Doesn’t this just fill you with joy?  In between articles promoting EHR’s, “Patient-Centered Medical Homes,” being “MACRA Ready”(!), and a hilarious bank of tips on how to beat burnout, the AAFP is now publishing this advertisement to enter primary care:

 “Study: Incentives Prompt Newly Insured to Seek Primary Care.”  Yep, more government-subsidized do-gooders have used someone else’s cash to study whether giving government-subsidized patients even more cash will get them off the couch and into their new doctor’s office.  We have been told for over a quarter century that primary care is IT, that it is needed, valuable, cool, fun, gratifying, and vital to the health of the nation.  The ACA cheerleaders told all of us that people wanted more doctors, especially the PriCare kind, and would make a beeline for the nearest clinic if only they had affordable insurance, which is why they needed to jack up premiums for the already-paying customers.

Researchers offered up to $50 for an initial primary care visit, and, and discovered, “The likelihood that individuals would make such a visit within six months of enrollment rose in relation to the amount of the incentive.”

Hoping someone will cry me a river, the authors wrote,  “Patients may view such a visit as unnecessary or daunting, particularly if they are unfamiliar with making appointments and communicating with physicians.”  I’ve thought the same of visits with accountants, attorneys, and the DMV, but no one ever offered me cash to go.  I went because it was in my self-interest, and I’m not a moron.  It’s not entirely clear whether all of the study subjects were strictly Medicaid, or covered by other low-income initiatives, but they are clearly all government-supported.  You can read the nauseating methodology, and decide for yourself whether it suggests any bias.  Did you know that, “The Patient Protection and Affordable Care Act expanded the ability of public insurance programs to offer financial incentives as a way to encourage patients to maintain healthier habits”?  Neither did I.

(get our free weekly newsletter. no spam. ever

One of the study authors “said the biggest limitation to the study was recruitment. A significant amount of potential subjects did not have stable phone connectivity, were homeless or incarcerated, making study enrollment a challenge.”  I’ll bet it did.

Why would anyone initiate such a study?!  “If the use of primary care is shown to reduce overall health care use and improve health in this high-cost population, cash incentives may be a cost-effective way to steer low-income patients away from more expensive services and help them establish a relationship with a primary care provider.”  Except this will do nothing to ease EMTALA-encouraged frivolous use of the ER, and will not decrease any defensive medicine costs.  It will not reduce any of the growing overhead burdens on the local PCP, nor will it put an extra dime of income in his pocket while he is being swamped with people who thought it worthwhile to come in once someone paid them to do so.  In other words, it will not encourage the local PCP to stay in business.

I interpret this study a bit differently than its authors:

  • People do not value what they receive for free.
  • Somehow society thinks it the obligation of its productive citizens to do for its non-productive ones.  I’m not talking about cripples, orphans, the bed-ridden, or mentally incompetent, but of otherwise able-bodied adults who are just too damn sorry to go to the office and accept the free care that someone else already had their own bills jacked up to pay for.
  • It is an economic truism that you get more of what you subsidize, in this case, people apathetic and lazy regarding their health, but…
  • …someone had better subsidize primary care docs a hell of a lot more than they are presently if they want to see more of them.

This story is a huge warning banner to anyone considering this toxic discipline, and it is hilarious that the AAFP would publish it as though it represented an exciting new idea.  It is one more insult heaped on the breaking backs of the family docs who still haven’t tunneled out or jumped the fence.

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] 

  6 comments for “So That’s All I’m Worth? by Pat Conrad MD

  1. Trixie
    August 20, 2017 at 5:50 pm

    And when you come in we’ll give you narcotics in order to beef up patient satisfaction. Basically, we’ll pay you $50 to come in for narcotics.

  2. p
    August 20, 2017 at 3:39 pm

    it is interesting that the knuckleheads who study this sort of thing never seem to get the point that medicine does not obey the laws of conventional economics. in most industries, innovation leads to decreasing costs; in medicine innovation leads to rising costs. this seems like another futile attempt to cram the round peg into the square hole. and i would totally agree that we do not value something if it is free.
    -p

  3. August 20, 2017 at 12:18 pm

    In Michigan, a prominent Medicaid provider pays $23 for primary care services. If this program went into effect here, they’d pay the patient twice as much as the doctor?!?! Forget Med school. It’d be more profitable to become a professional patient.

  4. August 20, 2017 at 9:37 am

    ‘Uber is excited to announce our new partnership with CMS. We will be providing free MediUberCare to qualified participants under a new provision of the Saving Americans from Disease Act proudly passed over presidential veto by Paul Ryan and Nancy Pelosi. With this new level of service we will finally be able to provide the high quality medical care that the federal government is known for!’

  5. HJR
    August 20, 2017 at 8:39 am

    F-ing A.

  6. Perry
    August 20, 2017 at 8:26 am

    Or like my insurance company will call the local minute clinic and make an appointment for you, never mind I already have an excellent PC doc!

Comments are closed.