New Possible Payment Models

In earth-shattering news, a new type of payment model has been proposed to HHS that would “provide greater financial resources to family physicians and primary care”. The answer?  Patients actually pay their doctors directly using cash, credit card or their HSA account.  A simple and effective approach that has worked for all businesses since commerce began.  Gotcha!!  I’m kidding.  Why would big bureaucratic groups want something simple?  They would lose their jobs if that happened.  No, instead here is the proposal by our friends at the AAFP:

The APC-APM would create a new payment structure for participating primary care practices consisting of a combination of four mechanisms:

• A prospective, risk-adjusted, primary care global payment for direct patient care;
• Fee-for-service limited to services not included in the primary care global fee;
• A prospective, risk-adjusted, population-based payment; and
• Performance-based incentive payments that hold physicians appropriately accountable for quality and costs.

Other features of the model require that physician practices be:

  • Fully flexible to accommodate differences in clinical settings and patient subgroups covered by primary care;
  • Able to be fully evaluated for quality and cost at the model and APM entity levels;
  • Reflective of the Joint Principles of the Patient-Centered Medical Home (PCMH) and the five key functions of the CPC+;
  • Attribute patients based primarily on patient choice; and
  • Adopt, and ultimately use, interoperable, certified health information technology, with the expectation that at least 50% of qualifying participants will use certified electronic health record technology (CEHRT).

Got it?  It’s so simple! Sure the quality stuff is unproven. Sure the PCMH and CPC+ is unproven. But who cares?  This all makes perfect sense to the “smart people”.  You know what also makes perfect sense? Scrapping it all.  But what do I know? I am just a lowly family doc in the trenches watching from the sidelines.

I also heard the AMA is coming out with their own payment model proposal that is all based on Monopoly money and scratch tickets. I am pretty excited about that one. Dilly Dilly.

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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 “New Possible Payment Models

  1. RSW
    January 18, 2018 at 10:56 am

    “Sure the quality stuff is unproven”

    Absolutely not true: quality measures have been PROVEN over and over again to not improve quality or reduce costs.

    Value-Based Payment Modifier: Outcomes and Implications | Ann Intern Med | ACP |

    Quality measures (i.e., blaming physicians for social factors over which they have no control) will destroy medicine the same way they destroyed teaching.

    The big difference: the NEA fought hard against this idiocy; the AAFP, led by the ever delightful Dr. Mullins, is providing us with precise instructions on how to bend over and grab our ankles.

  2. Chris Rhody
    January 18, 2018 at 8:22 am

    Time to unionize and not some wimpy union either. The question is, does the AAFP truly represent our best interest. We are mostly employed anyways and those who are not would still benefit from the standards we would set. And lastly, to stop the first argument, every single group (except government workers) that decided to unionize was told it was illegal. The AAFP and other groups purporting to represent us, have to return to and be limited to standards of education and practice, and provide quality education opportunities for the price of our dues. Instead they use them to lobby elected officials who rarely do anything that benefits us or our patients. It simply reduces access because we are either to busy doing this or spend a lot of money paying someone else to do it. And we are bright enough to not work for free. Although we do nearly that when we are an employee.

  3. Perry
    January 17, 2018 at 12:26 pm

    The bile in my throat just keeps coming up the more I read this stuff…
    They Just..don’t…get…it…

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