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.

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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.

103620cookie-checkSo That’s All I’m Worth? by Pat Conrad MD