You Do Not Satisfy Me

Imagine a world where you have no control of which patients come through your door.  A world where you have no control over how your practice is run.  A world where you still have to see 25-30 patients a day yet worry whether you are pleasing each and every one of them.  A world where you can get in trouble if one out of 500 patients was not satisfied and decides to complain to the hospital administrator.   A world where you can lose money because a patient ate himself into a heart attack or would not take her medication and her blood pressure was too high.  Actually, we live in this world.  Per this article in Forbes:

You are basically a number to be analyzed.  And if you do not satisfy patients enough then you will be punished.  Unless you do Direct Primary Care or some type of cash practice (specialists) then as the article states, “it’s only a matter of time before physicians will see the bulk of their compensation tied to quality measures if current trends hold.”

  • UnitedHealth Group, for example, reported earlier this year that nearly 60% of the insurer’s $130 billion in annual medical spending is value-based models.
  • And Aetna, the nation’s third-largest health insurer, and CVS Health, the large drugstore chain, have promised more value-based reimbursement models once their merger is complete later this year.
  • “In this digital age of instant gratification, medical practices need to take steps to remain competitive and keep their patients satisfied,” MGMA’s Fischer-Wright said in a statement to Forbes. 

Imagine CONTINUING to practice in this world where many patients act like King Joffrey from Game of Thrones.  Let me also remind you that the only evidence on these quality indicators and metrics shows that it DOESN’T work!  Let me also remind you that every organization that represents us in some manner (AMA, AOA, AAFP, ACP, etc) all support “working” with these groups and value-based reimbursement models.

The time to revolt is now before it is too late because it may be.

At least be well with one of our t-shirts. 

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 “You Do Not Satisfy Me

  1. PW
    July 9, 2018 at 12:13 pm

    And now this, more propaganda from ABFM:

    The American Board of Family Medicine (ABFM) and the ABFM Foundation are pleased to announce the establishment of the Center for Professionalism and Value in Health Care based in Washington, D.C. The Center will be led by Robert Phillips, MD MSPH, who has been named as its founding Executive Director.

    “Health care in the United States is in the midst of transformational change; professional self-regulation and the public trust are at risk. To meet this challenge, the ABFM Foundation has decided to make a strategic investment in the creation of the Center with the ultimate goal of dramatically improving health and health care,” said ABFM President and CEO Elect Warren P. Newton, MD, MPH.

    The new Center aims to create space in which patients, health professionals, payers, and policymakers can work to renegotiate the social contract. “The social contract between health care professionals and the public gives clinicians the privilege of self-regulation in exchange for responsibility to act in the best interest of patients. This contract is fraying as increased employment of clinicians creates pressures to serve business interests over those of patients. The erosion of autonomy, strain of regulation, and exploding reporting burden is producing unprecedented levels of burnout,” says Dr. Phillips. “It has gotten so bad,” continues Phillips, “that physicians are unwittingly asking many state legislatures to remove long-standing mechanisms of self-regulation and public accountability. We cannot afford to have the public question health professionals’ willingness to be accountable, and patients cannot afford our surrender of that role to payers and policymakers.”

    The Center will seek to define value across the healthcare spectrum, reaching beyond medicine to engage the broader healthcare community as well as patients and families to consider what they believe professionalism and value mean, how to measure it, how to improve it, and how to engage and develop leaders. The Center welcomes collaboration with all others interested in professionalism and value in health care, including other specialty boards, other professions, and other organizations interested in working together on this common ground.

    “The selection of Bob Phillips to lead the Center is an outstanding choice,” says James C. Puffer, MD, President and CEO of the ABFM. “In his role as ABFM Vice President of Research and Policy, he helped the ABFM Research Department grow to become an influential source of information about the value of primary care. He also led the launch of the national PRIME Registry, which now helps primary care practices in 49 states liberate data from their electronic health records, thus enabling easier monitoring and improvement of quality, measure reporting, and completion of certification requirements. He was instrumental in the creation and successful launch of the ABFM PHATE tool, which helps practices understand how their patients are affected by social determinants of health and how to meet their needs, as well as to support enhanced reimbursement.”

    Dr. Phillips graduated from the University of Florida College of Medicine and completed residency training and a health services research fellowship at the University of Missouri. Prior to coming to the ABFM, he directed the Robert Graham Center for Policy Studies in Primary Care. Dr. Phillips is an elected member of the National Academy of Medicine and was a Fulbright Specialist to the Netherlands and New Zealand. He currently serves on the National Committee on Vital and Health Statistics, is a Professor at Georgetown University and Virginia Commonwealth University and maintains a continuity family medicine practice in Virginia.

    They almost had me until this statement cropped up
    “It has gotten so bad,” continues Phillips, “that physicians are unwittingly asking many state legislatures to remove long-standing mechanisms of self-regulation and public accountability. We cannot afford to have the public question health professionals’ willingness to be accountable, and patients cannot afford our surrender of that role to payers and policymakers.”

    • Doug Farrago
      July 9, 2018 at 2:04 pm

      Where is the source for this?

      • PW
        July 9, 2018 at 2:28 pm

        Got it in my email from ABFM.

  2. RSW
    July 9, 2018 at 12:01 pm

    “value-based metrics such as patient satisfaction and outcome measures”

    And the medical societies across the board support this.

    Stupid or evil?

  3. Cliff Norman
    July 9, 2018 at 10:58 am

    Unintended consequences, Goodheart’s Law; “When a target becomes a measure, it ceases to be a good measure.”

    • Doug Farrago
      July 9, 2018 at 11:44 am

      When it is proven to NOT work over and over again (feel free to search this site for that) then is it still unintended consequences?

  4. Ben
    July 9, 2018 at 10:50 am

    I have been reprimanded because I told a 400 pound patient to lose weight and he did not like that. I have been reprimanded because I told a patient with a leg wound to quit smoking. And until recently my satisfaction scores have been lower because I would not hand out narcotics like candy, make up disability ratings, or classify a cosmetic surgery as medically necessary and get them FMLA paid by their government employer so they could have 6 weeks off, paid for a tummy tuck. Honest surgeons have been penalized for years.

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