Time to Do the Right Thing: End Fee-for-Service for Primary Care

I agree fully, having practiced in many models. Not only does FFS not make sense in the current world of technology it does not make sense in the current world of medicine where I can perfectly well help someone without a visit.

I make two comments -one constructive, one demonstrating a barrier. First, I know of two practices, one in NH, and my own, that have shown we can take of people for $1.00/day/ person with an incentive plan and low overhead, and the same with 2.00/per patient/day risk adjusted based on age - the medicare population in the NH case (presuming most are over age 65) though I would suggest under age 2 in addition.

But this takes us to the barrier. Doctors simply will not agree. As long as payors, agencies, civil servants, and bureaucracies divide us, we fall at making change. Simple capitation excludes devices like IUDs and supplies like vaccines but otherwise includes most everything. We must man up and stop quibbling over every dot of the i or crossing of the T.

If you do the math of a practice with 2,000 patients you would get 730,000 income into the practice. If overhead if the typical 66% or so (my own is 28%) the doc gets 240,0000 salary. Overhead will be lower as billing is simple ....

My practice has been capitated this way by a small payor for several yrs. I submit the bills to keep the bean counters happy about diagnoses and so forth. (and therein is the basis for the incentive plan) but I do not have to beg for money. I do not have to deal with 50% is care coordination or fear of audit becasue I omg used 99215 or worry about modifiers' influence in how much cereal I buy. I CAN "call it in". I get a monthly check. I can treat by phone or email if safe to do so. Doctors are going to have to step up. Let's move forward.

Competing interests: None declared