Know Thine Enemy by Pat Conrad MD

Years ago, I left my family practice clinic after my partner declined to move to a cash-only business.  We had never accepted Medicaid, and stopped taking new Medicare patients after two years, but still had all the penetrations, intrusiveness, and drag of third-party participation.  In what can certainly be considered a huge rationalization, I gave up my interest in the practice and went to the ER forever, paid an hourly wage, in my own version of “cash-only.”  You have read me here multiple times stating that Direct Primary Care is the only uncorrupted, honest medicine left, and I stand by that.  I consider government medicine to be corrupt and the enemy of anything decent remaining in the besieged and fraying doctor-patient relationship.

So it is worrisome, and predictable, that the Center for Medicare & Medicaid Services is trying to worm its way into DPC.  Niran Al-Agba, MD warns us about such slithering in “CMS Quietly Launches an Offensive Against Direct Primary Care.”  She explains that the 770-and-growing DPC practices nationwide have gotten the attention of CMS, which realizes that it’s repetitive models of “quality” and cost-containment are of course, failures.  Al-Agba notes two the two physician organizations that support the DPC model, the American Academy of Family Physicians (AAFP) and the Direct Primary Care Coalition (DPCC).  I know nothing about the latter and do not believe the former.  For years the AAFP has cheered for every dumb CMS idea, and for its occasional pro-DPC lip service, there is no record that they actually support it.  I’ve never heard of the DPCC (Doug, thoughts?), but it is a huge red flag that they would even talk to CMS.  As this piece points out, why should physicians that have totally opted OUT of Medicare even talk to them??

CMS is now trying to implement a “Direct Primary Care Prototype pilot program”, which involves Medicare re-enrollment, “pre-determined payments of $90-120/monthly based on patient age and complexity”, and “submission of patient data for payment.”  In other words, it is the opposite of DPC, hiding under that name.  It is a stinking lie that no actual DPC physician could possibly tolerate.

Our author tells us, “Representatives from both organizations were secretly present at the “listening sessions” last week, however, neither organization openly disclosed the CMS meeting to their general membership.”  Why would a DPC doc trust any organization that would even talk to CMS?

This is obvious, but scary stuff.  Al-Agba recalls that “Sun Tzu once said all war is based on deception”, and this is only the first feint of what will become increasingly open warfare by CMS against DPC.  To which I add from Musahi’s The Book of Five Rings, “Denigrate the enemy constantly, and with great spirit.”  CMS is, and forever shall be the enemy of DPC.  Anyone willing to deal with them deserves the predictable result.

EDITOR’S NOTE: I know very little of the DPCC. I know people who know them and they can leave their thoughts here. The DPCC has never talked to me nor do they represent me. The ONLY group that represents me is the newly formed Direct Primary Care Alliance, of which I am a founding member.  It seems crazy to me to leave the bogus metrics and data reporting behind just to jump back into it.  These meetings worry me as well. – Doug


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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] 

  5 comments for “Know Thine Enemy by Pat Conrad MD

  1. Steve O'
    March 10, 2018 at 3:23 pm

    “DPC” is being used to describe a permanent locum environment where a corporation contracts with a physician, who will receive a capitated salary and/or copays for seeing patients, and the company does the financials – including charging insurance if the patients have insurance. What does that have to do with Direct Primary Care? Nothing. How is it different from what we have nowadays? The physician will be a zero-hours contractor at will, who can be fired for any reason, such as non-performance.

  2. Perry
    March 10, 2018 at 11:53 am

    And so, the infiltration begins. I ask, how can one be DPC and also subject to the stupid Medicare BS that docs are trying to avoid in the first place? It makes no sense, other than CMS is trying to trick docs into thinking that they can do both and still be happy. I don’t think so. And AAFP continues to collaborate with the enemy.

    • rsw
      March 10, 2018 at 12:24 pm

      “AAFP continues to collaborate with the enemy”

      AAFP IS the enemy.

      • Perry
        March 10, 2018 at 3:16 pm

        Good point

        • rsw
          March 10, 2018 at 4:53 pm

          I challenge anyone to show me any evidence that the AAFP is NOT working to destroy family medicine as a viable career.

Comments are closed.