I don’t get it?

Dr. Horvitz writes ACOFP President Carol Henwood, D.O.:

I just read your email blast of August 19, 2014 promoting another ACOFP course, this time in patient centered medical homes, PCMH. It’s funny how patients are sort of mentioned, but it seems the real intent is third party payments, following third party rules and physicians paying for another course and taking time away from patient care.

I don’t get it?

“Creating team-based care improves efficiencies and decreases waste, which is exactly what payors like”
I thought our mission as physicians was to help patients and keep their needs first and foremost.

I don’t get it?

“It’s becoming increasingly common for payors to reimburse PCMH’s at higher rates and to include these practices in their network directories, says Harkins, who will be a featured presenter at”
So again, it seems like the ACOFP has joined the third party model and is trying to benefit from it instead of helping physicians remove themselves from the bureaucracy that makes it more difficult for a true doctor-patient relationship.

I don’t get it?

“Studies show that becoming “patient centered” where relationships with patients are nurtured so that they become engaged in their own health care, and a “medical home” so that patients have a base where care originates results in higher reimbursements, better care and less stress for you.”
How does becoming more corporate and having to fill out more bureaucratic forms and follow byzantine regulations make care more patient centered and nurturing?
Higher “reimbursements” are lost to the additional time and help necessary to become an NCQA approved medical home.

I don’t get it?

“Primary care physicians don’t spend as much time coordinating with specialists because protocols are already in place, says Harkins. It’s also easier to follow up with patients who need continual care.”
So let’s remove the peer to peer interaction between primary care and specialists and somehow that improves patient care? Let’s remove the physician to physician interaction and replace it with bureaucratic rules and mid level management. Let’s continue to reduce the job description of Family Physicians and somehow that will help our specialty, our profession’s future and the patients who come to us for care.

I don’t get it?

“Harkins concludes that to be designated a PCMH requires changing practice protocols and adding a tracking system in order to meet NCQA standards. To become a PCMH, practices are expected to submit surveys and provide documentation. The NCQA will review the documentation and designate your practice at a PCMH 1, 2 or 3.”

So in other words, do as we say, lose autonomous thought to the collective wisdom of NCQA, invest/spend money and time to track compliance with NCQA protocols and somehow, somewhere, someway it will improve individualized patient care and make physicians happier.

So the ACOFP is actively endorsing the corporate model of primary care whereby physicians become a cog in the system instead of steering the system as we did prior to the advent of managed care and government intrusion into care.

I don’t get it?

“To learn more about the Medical Home recognition process and advantages for your practice, I encourage you to register today for ACOFP’s Medical Home Workshop, September 13, in Chicago. The registration fee is $245 and includes a continental breakfast and lunch.”

Wow, breakfast and lunch served!

Ohhhh, now I get it!!!

The ACOFP has become another organization looking to enrich itself with its physicians members money by hosting pay for play courses.

The ACOFP is following the playbook of other physician organizations that endorsed the ACA and will continue to try to control its members as opposed to helping them create practice styles that work for them, their communities and their patients.

I don’t get why the ACOFP has not fully endorsed direct pay practices as a very viable option to increase the strength of primary care. The AAFP has fully endorsed and is backing the direct pay model.

When will the ACOFP start listening to its private practice members instead of just following the third party payers over the cliff into an even more government controlled system?

Why the delay?

I don’t get it?

Steven Horvitz, D.O.
Moorestown, NJ

2 thoughts on “I don’t get it?

  1. Perhaps I have missed out on important parts of the conversation between you and ACOFP (Dr. Henwood), but I am disappointed that this is the part I stumbled upon. If you are advocating for medicine that is patient-centered, this is not the way to do it.

    I should start by saying I am a big fan of the direct primary care (DPC) model. I think it provides a way for doctors and patients to spend more time together while at the same time decreasing costs for the patients without putting too much of a cost burden on the physician. Among other things, patients get better primary care with less waiting time for less cost through DPC. However, I should be quick to add that DPC is not a perfect solution to all the issues faced in primary care. I think the biggest issue I personally struggle with (and perhaps you have an answer to this) is that DPC does not provide an answer to the doctor shortage. Instead it exacerbates the problem by limiting the number of patients a DPC doctor can see. Additionally, DPC is not for every patient. I don’t see the viability of chronic illness being treated via DPC (although I would be happy to be proven wrong. Perhaps you have a solution for that, too).

    As I understand it, a Patient-Centered Medical Home (PCMH) is trying to answer many of the same issues as DPC but in a different way. If it works the way it is designed, PCMH provides comprehensive, patient-centered care that is higher in quality and more accessible for patients. It also does that without leading to doctor burnout and without (to my knowledge) exacerbating the doctor shortage. Sure, it doesn’t provide the doctor/patient relationship and cost-effectiveness of DPC, but it still has its virtues.

    I have noticed there is far too much divisiveness and partisanship in the world today. Instead of attacking different approaches to solving a problem, we need to come together and find common ground. From there, we can begin building the best medical system for both patients and doctors. I recommend we start by acknowledging you are both working to improve patient care while decreasing physician burnout. Let’s start with that and then build up from there.

    • Student Dr. Carter,
      Thanks for taking the time out of your busy academic schedule to learn about what’s going on in the practice of osteopathic and allopathic medicine today. When you finish your residency training, you’ll find that both the AOA and AMA and ABMS want to have you pay them every eight years for the rest of your career. Also, you’ll find that the government wants to limit your practice to the algorithms they approve of. These are the two issues that led to the poisoning of the concept of PCMH. Running an office in medicine may not even be an option for you due to all of the government and special interests stealing patient time and money. Stay in touch as you get more training and consider joining AAPSonline.org. Good luck to you in your pursuit and ideally, you will become and informed physician and leader in healthcare.

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