Leadership: Let patients decide what quality and value means to them

Michael Strickland, MD writes in:

In the face of CMS’ own predictions, Andy Slavitt says “Despite what the table shows, our data shows that physicians in small and solo practices can do just as well as those in practices larger than that.”

I’ll believe that he, and others like him, know what they are talking about when I see them start picking up charts, seeing patients, and relieving their danger and distress, while using the systems they are so eager to mandate. I have medicaid and medicare patients who pay me cash, because they have problems they cannot get solved by their ‘providers’ who are being directed by these people, and I openly invite Andy Slavitt, President Obama, Hillary Clinton, Zeke Emmanuel and anyone else advocating this to visit my office in Cincinnati and show us how it’s done.

The first thing I was taught on the first day of medical school was “We know that 50% of what we are going to teach you is wrong. We just don’t know which 50%.” This wisdom is not one iota less true today than then, but these guys must have been sitting L rear that day. No, actually, most of them weren’t there at all, and missed the grueling 7 years that followed. I guess when you are born not only knowing how to practice medicine today, but for all time to come, so that you are certain that your interpretation of the data is correct and ever shall be, and thus you have the right to impose that interpretation on everyone else, then going to class and call is a waste of time.

IdealMD.com reports:

“Surveys of 700 direct primary care practices, which represent approximately 215,000 patients, found that quality measures like blood pressure control, diabetes control, immunization percentage, screening for cancer, etc. are substantially better than a comparable group of individuals not in a membership practice. Also there is a very substantial reduction in total medical care costs of $2551 per capita.

This is a result of fewer referrals to specialists, fewer prescriptions, fewer hospitalization and fewer trips to the ER. As to satisfaction, perhaps the most important marker is that few individuals leave Direct Primary Care practices. In addition, Direct Primary Care resulted in 35% fewer hospitalizations, 65% fewer emergency department visits, 66% fewer specialist visits, and 82% fewer surgeries than simi­lar populations–though these reductions in costs may not directly impact the wallet of all patients, they do add up into a substantial dollar savings for those with a high deductible policy.”

We have been wrestling with this problem for decades: how to bring the spiraling cost of healthcare under control. DPC is doing it, now. Throw most of these programs and acronyms in the trash, keep the budget neutral, pay docs a simple capitated monthly fee (the $50-100/mo we r making on our own. Not the $13/mo billionaires like Slavitt (who couldn’t treat a wart)/UHC tried to offer us in the 90s), and let’s get back to treating patients and reading the science. Let patients and colleagues (people who put their lives and their reputations on the line) decide what is quality and value.

Michael Strickland, MD

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