It Was Never About You

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I worked for two hospitals over my first 15 years in family medicine. I dealt with a myriad of health administrators in every role possible. It was always the same. As far as patient care was concerned, they never knew what they were talking about, but they always had a new initiative that they were excited to force down my throat. These were some of the quality metrics rolled out over the years:

  • Physician Voluntary Reporting Program (PVRP)
  • Physician Quality Reporting Initiative (PQRI)
  • Physician Quality Reporting System (PQRS)
  • Medicare EHR Incentive Program / Meaningful Use (MU)
  • Physician Feedback Program / Value-Based Payment Modifier (VM, VBM, or PVBM)
  • Quality Payment Program (QPP)
  • Merit-based Incentive Payment System (MIPS)
  • Alternative Payment Models (APMs)

They all failed as I knew they would. I would explain to my bosses that you really can’t define the word QUALITY. The result is either:

Campbell’s Law, which notes that the more a quantitative social indicator is used for decision-making, the more it is subject to corruption pressures and the more it distorts the processes it is meant to monitor.

Or:

Goodhart’s Law, which states: “When a measure becomes a target, it ceases to be a good measure.”

They didn’t care because their bonuses and jobs were based on this garbage. No matter how much I protested, it NEVER mattered. Hell, the institutions that supposedly supported us (AMA, AAFP, ec.) all backed these same initiatives.

That is when I realized the new initiatives were never about my patients..

It was always about them, the administrators. That is what the above video represents to me.

DIRECT PRIMARY CARE changed all that for me. Campbell’s Law and Goodhart’s Law no longer applied. It was about doing the best for each individual patient.

That’s the difference.

It’s about the patients.

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About Douglas Farrago, MD

Dr. Farrago is a retired family physician based in Forest, Virginia. Since 2021, he has run DPCnews.com, a leading resource for the Direct Primary Care (DPC) movement. He is the author of three best-selling books on Direct Primary Care: The Official Guide to Starting Your Own Direct Primary Care Practice The Direct Primary Care Doctor’s Daily Motivational Journal Slowing the Churn in Direct Primary Care (While Also Keeping Your Sanity) In 2016, Dr. Farrago conceived the idea for the Direct Primary Care Alliance and co-founded the organization alongside other pioneering DPC physicians. He is widely recognized as a leading expert in the DPC model and frequently lectures to medical students, residents, and practicing physicians on how to successfully start and run their own DPC practices. Dr. Farrago sold his Direct Primary Care practice in October 2020.