One pet theme of most D-PCPs is, “Who can better determine quality better than my patient?”, a question invariably coupled to its speaker’s brag about a high patient retention rate.
And yet, in the Union County employee DPC clinic study, the actuaries observed a huge risk selection bias against the DPC, enough to require a 8.3% risk adjustment. Yet, the actuarial values of the competing DPC and FFS were very close to each other. So if cost did not drive the adverse selection made, what did?
A commonly given explanation is that older, sicker patients preferred sticking with their established PCP rather than being forced to choose between a small number of doctors working for the DPC clinic.
But does this not evidence that access to a larger community of fee for service doctors produced quality care? After all, who can better determine quality than those chronically ill patients who turned down DPC clinics?
Why would anyone expect that spreading the annual compensation of a primary care physician over one-third as many patient panel members would result in cost savings?
Why would anyone expect that finding a physician to give quality care that matches her needs among no more than two thousand direct primary care physicians would be more likely than finding quality care that matches her needs among the one hundred and fifty thousand who accept insurance?