AAFP Continues To Give Full Support For More Bureaucracy

I still hear that the American Academy of Family Physicians is all we have as family doctors in terms of support. There is some truth to that but that is only because no other group has stood up and taken the reigns from them.   A 15-page letter (yes, 15 pages) signed by AAFP Board Chair John Meigs, M.D., of Centreville, Ala., noted that the Academy’s recommendations are meant to “continue to strengthen primary care for Medicare beneficiaries, to enable more physicians to participate in Advanced Alternative Payment Models (AAPMs), and to further reduce the administrative and regulatory burdens family physicians face in the Merit-based Incentive Payment System (MIPS)”.

I am at the point in my career where I actually think I am reading another language when I see this crap.  I am told the AAFP is going to fix family medicine with the following:

The AAFP relayed its support for portions of the QPP and suggestions for improving other sections by:

  • expressing support for an opt-in pathway for family physicians and other MIPS-eligible clinicians who fall below the agency’s low-volume threshold;
  • suggesting it would be “both beneficial and logical” if physicians in similar practices who are part of a larger multispecialty group reported quality as a smaller subgroup;
  • asking CMS to ensure there is parity in quality reporting by insisting all eligible clinicians submit data on six measures using cross-cutting measures if necessary; 
  • opposing use of certain measures in the QPP — specifically, Medicare spending per beneficiary and total per capita cost — because those two measures were intended for use at the tax identification level and may not be valid at the solo/small practice level;
  • requesting that CMS hold physicians harmless in the cost category if they cannot be “reliably measured against at least one episode-based cost measure” and do so at least until CMS can create a “more even and meaningful playing field;”
  • reiterating concerns about complex scoring in the MIPS performance categories;
  • supporting CMS’ exemption of alternative payment model entities enrolled in round one of the Comprehensive Primary Care Plus program from the Medical Home Model-eligible clinician limit, and urging the agency to extend the exemption across the board;
  • agreeing with CMS’ suggested definition of “Other Payer Medical Home Model” and suggesting ways to strengthen the primary care emphasis;
  • calling on CMS to make payers responsible for submitting relevant information on payer arrangements;
  • giving full support to the Physician-Focused Payment Model Technical Advisory Committee’s role in evaluating physician-focused payment models;
  • and remaining in full support of CMS’ plan to establish a policy for extreme and uncontrollable circumstance policies for the MIPS performance categories without requiring clinicians to submit an application.

I am not the smartest guy in the world but I see a ton of words like “support”, “agreeing”, “remaining in full support”, etc.  They write this stuff as if they are a pre-teen scribbling a note to his/her crush and then worrying that it may come off wrong.

Why would any doctor want to give money to this organization so they can sit around and pay their lawyers to come up with this crap?

This healthcare system is a big, smelly turd and the AAFP continues to brag about how well they can polish it.  Direct Primary Care is Michelangelo’s David compared to this garbage and they ignore it like it is an eyesore. My hope is that someday family docs leave industrialized medicine and leave the AAFP because both are broken.

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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] 

  7 comments for “AAFP Continues To Give Full Support For More Bureaucracy

  1. Pat
    December 23, 2017 at 9:18 pm

    Sorry Doug, I literally could not read through the entirety of that bilge. No semi-intelligent US medical student could possibly read this and exclaim, “Yeah!” Sure, a bedraggled internist from Whoknowswhereistan might think that being a 60-80 hour/week serf for $90 K is pretty sweet – perspective is everything – but no one with a realistic choice at a better life should get anywhere near this toxic gunk. Yes, go into primary care IF it is DPC from the start and IF you realize you will be increasingly targeted and hounded by those threatened by DPC, and can accept that risk. If you take anything the AAFP says seriously, then you should consider leaving medical school and do anything else before you ruin your future.

  2. Max O'Reilly
    December 23, 2017 at 2:05 pm

    When will AAFP members join IM brethren in revolt against MOC monster??? All PCPs must stop paying into MOC! Worthless Waste of Time Money Sanity that it is. If you are paying your boards and hoping to keep your job while someone else fixes the problem you are part of the problem.

  3. Perry
    December 23, 2017 at 11:35 am

    Unless there is a revolution in Primary Care, FPs will cease to exist in the near future. No one should have to put up with this crap.

  4. December 23, 2017 at 10:28 am

    Short, sweet and brilliantly to the point, once again Doug! Bravo!

  5. Stephen O'
    December 23, 2017 at 10:19 am

    I found the following open letter.

    Dear Administrator Squidge:

    On behalf of the American Boards of Medical Specialties in administrative partnership with the American Academy of Family Physicians (AAFP) which represents 129,000 family physicians and medical students, thrashing about in Weberian bureaucratic hell across the country, I write in response to the interim final rule with comment period titled, “Medicare Program; CY 2018 Updates to the Quality Payment Program; and Quality Payment Program: Extreme and Uncontrollable Circumstance Policy for Generation of Bureaucratic Nonsense” (CMS–5522–FC and CMS–5522–IFC) as published by the Centers for Medicare & Medicaid Services (CMS) in the November 16, 2017, Federal Register, to offer a proactive proposition of great potential potential.

    The American Board of Specialty Messes is moving ever forward to take proactive action regarding the deficits in administrative and bureaucratic medicine in the American medical business optics buzzwords, which are unfortunately underutilized because of heuristic patterning in medical administration.

    We have received universal cheering and approval from our terrified member-spectators to announce a new Postgraduate Medical Training in the ever-emerging and increasing field of Bureaucratic & Administrative Medicine. Our MBA fellows will soon be capable of frontlining cross-cutting policy analysis, which can also cover issues that are themselves cross-cutting in nature!

    Moving forward, we envision the inbuy of stakeholders such as Federal organizations beyond CMS in moving forward to develop an integrated, evidence-based task-modulated answer to the shortfall in capabilities in administrative medicine now leading to quality chasms and deficit deficits in medicine. Moving forward, we envision several opportunities to support multinational workforce support in driven innovation actions in medical synergy.

    The Fellows of the Fellowate of MBA (Bureaucratic & Administrative) will be eligible for MOC maintenance of their specialty and subspecialties (AM and BM) by continuous quality maintenance involving the surgical implantation electrical gizmos and thingamabobs that can detect any learning going on, and providing state-of-the-art communications interfacing of certification-related quality management material.

    One out of every five office visits in the United States are with family physicians. This translates to more than 192 million office visits with family physicians each year. This is 66 million more office visits than the next largest medical specialty. More Americans depend on family physicians than on any other medical specialty. This shocking and reckless squandering of resources must be addressed immediately.

    We see that the MBA will shift seamlessly into the outdated ASP model (the Actual Seeing of Patients.) Only by elimination of ASP can the cost-benefit curve be prospectively shifted towards savings.

    MBA physicians are dedicated to treating the whole integrated documentary profile, from birth to death certificate. Babies with ear infections, adolescents with depression, adults with hypertension, and seniors with multiple chronic illnesses are not filling up MBA waiting rooms, full of complaints and snot.

    We hope for lucrative support for an opt-in pathway for family physicians and other MIPS-eligible clinicians who successfully fall below the agency’s low-volume threshold. All non-profit non-state actors and are potentially eligible for inbuy in this metric.

    We appreciate the changes CMS has allowably allowed in certain interim final rules permitting the endorsement of recognized recognition by the ABMS for expertise in MBA; many of which were significant steps to improve the ability of MBA physicians to participate successfully in non-compete agreements with the standard government loafers and freeloaders. It is hoped that advancement of fellows to the JD-MBA combined programs will solidly arrest any changes in medicine threatened by ASP activities.

    In summary, we summarize that a bright new world threshold will be overrun in the quest for the measurement of quality through quality measures and hope to exceed our success in the Meaningful Uselessness Program in punishment of actual medical utilization of stuff. We hope to continue to do nothing useful, but with great precision and think-back of feedforward evaluation synergy. It’s incumbent upon us to utilize and leverage our core competencies to maximize our traction in the vertical government-practice interface,by restructuring to maximize our potential. Cross-cutting policy analysis can also cover issues that are themselves cross-cutting in nature. The results of fellowship training will be best valorized for both the public and private sectors, and the implementation of the actions included in the training scenario roadmap will be assessed in the framework of joint annual forums. CMS will appreciate a win-win game for all stakeholders in this venue.


    Dr. Ron McDonald AAFP, FMBA
    Dean of Bumf-Shuffling, Stanford Medical Center

    • Perry
      December 23, 2017 at 5:20 pm

      You should post this in the AAFP website.

    • Vise
      December 24, 2017 at 5:27 pm

      OMG this is just brilliant!!! All physicians must unite in this fight for sanity and survival of American medicine! We must all fight against this meaningless abuse of physicians, because no one will care better of our patients! All the best!
      Vise (derm)

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