Ridiculous Study of the Week?

I had to put a question mark on the title of this blog entry because I couldn’t tell if this study was actually ridiculous or not.  Researchers found that the annual number of primary visits for Medicare patients was inversely proportional to the number of ED visits, hospitalizations, and cost of care. I am simplifying their results a bit but you can read it yourself.  It so simple that it makes you want to say “duh”.  But it is also pretty profound in its own right.  If you get patients over 65, who have the most medical problems in our population, to regularly go to their doctors then they are not clogging up the ED, getting so sick they need to be hospitalized and this all saves tons of money.

Now what kind of medical office could handle seeing Medicare patients regularly?  What kind of practice has the time to spend with them?  Hmmmm, I wonder?  Of course I am talking about Direct Primary Care.  For a low monthly fee these people are truly given comprehensive care with the time they need to prevent a lot of problems down the line.  Heck, Medicare could be paying this monthly fee and save tons of money for all the taxpayers.  Too easy?  Yup. Instead, the idiots in charge would make us measure everything with bogus metrics and quality measures making these visits a joke once again. The annual Medicare visit as it is now, in regular offices, doesn’t even require an exam!  I just saw a new patient in his late 80s.  He had been seeing his doctor for annual visits regularly for years but when I did my full exam I noticed an obvious neck mass.  All I had to do was look.

To prove my point, the authors of this study show how to screw a good thing up:

Measuring the temporal regularity of PC visits may be useful for identifying beneficiaries at risk for adverse events, and as a barometer for and an impetus to clinic-level quality improvement.

Swing and a miss. Instead of saying that it is extremely important for Medicare patients to see their primary care doctors regularly they want to create some surveillance program to find those people who are not being seen. I’m sure that won’t cost a lot of money.

Here’s an idea.  Let’s Medicare patients a medical credit card that they can use to pay their DPC docs.  Don’t do the stupid little metric game but after a year or two compare the ED visits, hospitalizations and cost for those who stayed in the system versus those who had a DPC doc.  My money is on the latter.

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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] 

  4 comments for “Ridiculous Study of the Week?

  1. Pat
    November 11, 2018 at 12:13 pm

    Medicare is the genuine cornucopia for the statist. This awful program has a stranglehold on not merely medicine, but the national economy, which truly has made debt a security issue.

    The program rests on unrestrained demand, and there is no disincentive for the Boomer retirees to hit the ER whenever they like. The inflation guaranteed by this pyramid scheme that would make Bernie Madoff blush means endless attempts at cost containment, all falling on those who do the damn work.

    Consider that with growing longevity, the hilarious failure of cost containment rests in these costs never decreasing, but being deferred. In the additional years alive achieved by unproven “quality,” the retiree only costs MORE. Instead of just incurring expensive end-of-life costs, we keep ponying up for all sorts of chronic problems-care for a couple extra decades and THEN do the ER-ICU two-step. Of course a ninety year-old will cost more than someone more politely stepping aside at 75.

    Medicare has induced more billions than we could count in unnecessary costs via JCHAO, quality moronics, EHR games, Part D subsidized pills….on and on. No one will touch it, for political fear of enraged, greedy seniors with too much free time, and their families who want to pass the buck.

    This is genuine intergenerational theft, and the ready made pathway to fully nationalized care. Medicare has made the health care system, and likely the economy at some point, into a national mausoleum.

    No if only we can get it to pay for those walk-in tubs and discounts for those wanting to convert to all-gold IRA’s.

  2. November 11, 2018 at 9:48 am

    Too easy, Doug.

    Besides, where’s the opportunity for the intermediaries (insurance, PBMs, hospitals and politicians) to make money? (aka graft, corruption and otherwise feeding at the trough).

  3. James Tinsley
    November 11, 2018 at 9:32 am

    Here’s an idea. Let’s Medicare patients a medical credit card that they can use to pay their DPC docs.

    I respectfully disagree with this as I have been a mostly Medicare Physician driven out of business. Medicare will control what you get paid. How about the patients pay cash then beg Medicare for the reimbursement. He who holds the money holds the power. A powerful lesson I have learned to my detriment.

    • Doug Farrago
      November 11, 2018 at 8:44 pm

      That would work too

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