Quality metrics are unproven. They are a moving target. They are what's wrong with medicine…
When Ivory Tower Idiots Attack DPC
A recent JAMA article called Direct Primary Care One Step Forward, Two Steps Back recently came out and they did their typical routine of attacking DPC. In the article they say:
Proponents of DPC argue that the model generates system-level cost savings, improved patient outcomes, broader access to care, and clinician and patient satisfaction. Because DPC models do not rely on fee-for-service reimbursement, physicians are able to devote resources to previously nonbillable care coordination efforts. With a smaller patient panel and because DPC physicians do not bill third-party payers, physicians can focus on building therapeutic, longitudinal relationships with patients. DPC advocates suggest that these changes yield significant improvements in both patient and population-level health outcomes, reducing the rates of hospital readmissions, specialist visits, radiologic and laboratory testing, and emergency care.
Okay, so far, so good but then they go on to say:
“Individual DPC practices have indicated that practice-level data on outcomes support these claims; however, no study, to our knowledge, has produced data to support anecdotal claims by individual practices.”
Okay, to their knowledge, there is no evidence but then they go ahead and basically say we are going to cause tons of problems including:
- Targeting healthier patients and declining coverage to the ill.
- It is unlikely that patients most in need of care would be willing or able to afford an appropriately risk-adjusted retainer in a DPC setting.
- DPC fails to address fundamental market inefficiencies and facilitates a substantial gap in catastrophic coverage
- DPC circumvents the quality metrics and incentive structures designed to improve population health and reduce national health care expenditures. DPC practices once held accountable through value-based payment systems have no obligation to report or measure quality metrics.
- Lessons learned from DPC—mainly the potential utility of global capitated payments—should be applied when developing new payment reform models and envisioning a new future for primary care delivery. However, DPC is not the answer to the problem
Remember when they said there was no evidence? So, all their “conclusions” are based on what? Fear and hatred. This article was written by ivory tower “doctors” from Warren Alpert Medical School. They do not want DPC to succeed but it is succeeding and that pisses them off. In fact, this article in Medical Economics by Kimberly Corba DO shows that DPC may be the link to the “fourth aim”, which is “improved clinician and staff work life.” Now you can really see why his makes them mad. These non practicing doctors do not want practicing doctors to enjoy their patients and their career. They want us stuck under their control and to be their guinea pigs as they experiment on us with any new bogus fad like quality metrics and healthcare teams. But again, these are NOT proven either. Their logic is ridiculous.
Our jobs are simple. Doctors see patients directly without the interference of the insurance companies, the government or these ivory tower idiots. Their big complaint is that we cherry pick but the truth is that everyone one of us see very complicated patients of all races and socioeconomic status and most of us give away 5-10% of free care. And we do a better job with these patients because we spend time with them. For the rest we charge a very reasonable price, less than a cell phone bill or a cable bill.
I for one would like to respond to these authors, and every other critic of DPC, by saying “Be Well”. You can try all you want to stop us but it’s not going to happen. We get the last laugh while you are stuck in your miserable windowless office trying to make yourself feel important. The truth is…you aren’t.