Participation in the Comprehensive Primary Care Plus Initiative

The authors give a description of which kinds of practices applied to, and participated in, CPC+. CPC+ is beloved by many policy makers. It saved no money. I am not aware of data about improving care and it may be too soon. At one point, for some reason, I called three CPC+ practices to ask about the project and I could not even get to speak to anyone. That speaks to me about access, which is the crucial point for patients.

It seems to me this article misses the bigger picture--that of practices that did not apply, because they were excluded by design of the project. This happens over and over. Atul Gawande was on Twitter last week praising Massachusetts Blue for a new payment model for "small practices."
But one had to have 1,000 payers on the plan to be in that project. That is not a small practice.

Small practices were excluded from applying to CPC+, so saying that participating practices tended to be larger seems to miss the point. Maybe I am missing something, but I know dozens of stellar small practices all over the country that are cut out from or dismissed from many initiatives due to size. I understand that small size interferes with measuring. But I do not care. For 32 years I have seen specialists steal my RVUS and watched as my profession limited its scope. Now it has been reduced to a clerk send questions about our regular patients.

I am the author of an extremely innovative payment proposal that PTAC submitted to DHHS for trialing. It gathers dust. We are killing primary care by exclusion of practices from projects. Was this a rant? Well, then, let's rant till we are heard. I am not slick or reserved. I have done my work and found that no good deed goes unpunished.