Your Weekly “WTF” Recommendation from the Experts

Here’s one from the Annals of Family Medicine Research and brought to you by our good friends at the AAFP.  It’s called Use Field-tested Tactics to Improve Care, Reduce Costs and I just bet by reading the title your bullsh$t detector is going off full blast.

The article first points out why MIPS has failed and “that ongoing programs aimed at helping physicians improve care quality and lower spending have failed to show consistent, across-the-board progress in these areas.” Do they come up with an answer?  Yes.  Is it the right one? No. The researchers/experts did the following:

  • Thus, they set out to look at a small national sample of primary care practice sites to “reveal attributes of primary care delivery associated with high value.”
  • After developing a ranking process for quality that was based on 41 measures, researchers visited 12 high-value primary care office sites and four average-value sites between May 2013 and June 2014.
  • Site visits lasted eight hours and were conducted by a primary care physician experienced in practice assessment and a nonphysician qualitative researcher. Visiting teams conducted interviews including “open-ended questions aimed at identifying attributes that interviewees felt might account for their practice site ranking favorably.”

Let’s point out the problems with this. They use a small sample. They find practices of high value, which really seems pretty subjective to me.  They develop a ranking process for quality based on 41 measures.  Once again they use “quality” as their standard and that term is undefinable. It’s a moving target and means one thing to some people and other things to other people or patients. They then give their findings which are:

  • expanded access including same-day appointments, walk-in availability and extended evening and weekend hours;
  • shared decision-making and advance care planning;
  • patient feedback — positive and negative;
  • comprehensive primary care where physicians practice within the full scope of their expertise;
  • upshifted staff roles that allow physicians to devote more time to the most complex patients;
  • shared workspaces where care teams can communicate face-to-face; and
  • low practice overhead costs for office space and equipment.

All this all screams DPC but with tons more overhead and headache.  Anyway, here are the buzzwords and soundbites they go on to write in this AAFP piece:

  • care traffic control
  • represents an advantaged platform for care coordination
  • ease cognitive burden
  • signals the usefulness of echoing within a practice external efforts to reward value rather than volume

I don’t even know what this means. The only comment left on the website was perfect:

“Great article for a healthcare widgets and wonk person. I wonder what the results would look like if designed by Doctors and patients instead of academicians. Many of the conclusions seem strained and preconceived to fit a mold that was already cast….”

Exactly.  Or, family doctors could do Direct Primary Care and all this is solved.

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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] 

  3 comments for “Your Weekly “WTF” Recommendation from the Experts

  1. Perry
    December 2, 2017 at 7:15 pm

    The talking heads keep wanting to fit square patients and docs into round holes. When will they ever realize it won’t work?

  2. RSW
    December 2, 2017 at 11:07 am

    I think I need more “upshifting” in my office.

  3. Steve O'
    December 2, 2017 at 10:59 am

    In evolution, you get what you select for. That’s what Darwin saw on the Galapagos. Birds occupying a certain food niche had characteristics that favored efficiency in consuming that food. Evolution exists. It does not require much theory; none, in fact.
    If you wish medicine to occupy the niche of corporate retail services, as does the fast food industry and retail auto parts, you “show” that this model is evolutionarily “good.” Unlike Reality, which is harsh in its enforcing its dicta, human enterprises may go off onto any sort of tangent which they consider “good.”
    It is not long ago that homeopathy and naturopathy were coequal to allopathy; and even today, these postulates are not seen as without any scientific merit. People wanted to use homeopathy, and saw “effects” which they genuinely believed were real. For a very brief time, objective scientific research was used to guide allopathic medicine, until it was discovered that whomever owns the “truth,” owns the future.
    The Corporate/Retail Model is already considered the future; why not show that the future is “good?” No revolutionary promises mediocrity and shabbiness. A sample of 16 clinics openly selected for – a failure in intent to avoid sample bias – is so small, the statistical inference is rubbish.
    For those who dig on statistics, this paragraph analyses them. Of this sample size, at a 50% chance of selection of either “superior” or “inferior” clinic, just by absolute chance, the smaller sample size – the “average value sites” will be 100% perfect 3.79 % of the time, and 0% failed the same. Taking any sample set of 4, simple random chance will produce these numbers.
    How do you know you’re really looking at measures of a “superior” clinic in this study? By simple sampling error, your risk of discovering something that scores 100%, 0.001% of the time per test, and the same for some variable scoring 0%.

    I did not look at their paper, but usually, dimbulb data-wonks lump in huge numbers of elements in a sample set. Here is why. This is exactly why data is collected by the metric ton. If they were to include clearly bogus statistics, like “percentage of male physicians in the practice who are not circumcised,” several of these brainless measures would show up as significant. Perhaps they should ask a urologist to accompany them on their data collection rounds – although if the urologist is as incompetent as the study authors, someone could wind up losing a finger.
    We have surrendered medicine to the superstitions and fads of the day, wearing the rainments and trappings of science and statistical analysis performed by fools. These “scientists” can prove war is peace and freedom is slavery, down to the third decimal point. Ask them.

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