Who’s On Primary Care First?

Haven’t we seen this crap before? It is the same routine over and over again. It’s a stale act:

Primary Care First is a set of voluntary five-year payment model options that reward value and quality by offering innovative payment model structures to support delivery of advanced primary care. In response to input from primary care clinician stakeholders, Primary Care First is based on the underlying principles of the existing CPC+ model design:  prioritizing the doctor-patient relationship; enhancing care for patients with complex chronic needs and high need, seriously ill patients, reducing administrative burden, and focusing financial rewards on improved health outcomes.

So, remember that What is on Primary Care Second. And “I Don’t Care”? Our Primary Care Shortstop.

All one big joke. I’ll take Abbott and Costello over the government every time.

Lou Costello: You gonna be the coach too?

Bud Abbott: Yes.

Lou Costello: And you don’t know the fellows’ names?

Bud Abbott: Well I should.

Lou Costello: Well then who’s on first?

Bud Abbott: Yes.

Lou Costello: I mean the fellow’s name.

Bud Abbott: Who.

Lou Costello: The guy on first.

Bud Abbott: Who.

Lou Costello: The first baseman.

Bud Abbott: Who.

Lou Costello: The guy playing…

Bud Abbott: Who is on first!

Lou Costello: I’m asking YOU who’s on first.

Bud Abbott: That’s the man’s name.

Lou Costello: That’s who’s name?

Bud Abbott: Yes.

Lou Costello: Well go ahead and tell me.

Bud Abbott: That’s it.

Lou Costello: That’s who?

Bud Abbott: Yes.

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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 “Who’s On Primary Care First?

  1. Steve O'
    May 7, 2019 at 4:05 pm

    A CMS masterwork. Anyone who knows government, knows that the real story is in the budget, not in the bill. One can propose flying rainbow unicorns for every practice. No funds – no unicorns this year.
    Here’s a howler:
    “In an effort to increase access to primary care and patient engagement, CMS is exploring beneficiary engagement incentives and payment waivers. “
    The first part is gabble. Patients should consent to treatment, if that’s what they mean by beneficiary. shared decision making, urging adoption of the process to improve physician-patient communication and informed consent in health care. Although it has been 30 years since the Commission urged the adoption of shared decision making, beneficiary preferences and values about medical treatment choices are still routinely left out of important discussions between practitioner and beneficiary
    The second part sounds suspiciously like someone waiving being paid for something. It’s an old dodge in the government wish list – if only doctors wouldn’t charge for their services, healthcare would be more affordable! (actually, payments to physicians is usually about 10% of total healthcare expenditures, but it’s a start.).
    Give the patient what they want for free. Yah. What if their value basis integrates the concepts of doing nothing and getting free narcotics? Who can say? Who’s on first? I don’t know.

  2. JRDO
    May 7, 2019 at 1:31 pm

    If I understand DPC correctly, it’s a big fuck-you to the bad guys (administrators and insurance companies). I like that.
    Primary Care First seems a disingenuous way for the bad guys to reinvent their leeching.

    • Douglas Farrago MD
      May 7, 2019 at 1:58 pm

      spot on

  3. RSW
    May 7, 2019 at 8:26 am

    You left out the best part – you have to assume down-side risk. You can’t set the rates and you can’t control expenses, but you sure can get hit for any losses.

    All the while those s***-eating whores at the AAFP are doing a non-stop victory dance as they thrust another knife in the back of the membership.

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