Author Archives: Gary Ratner

The “DPC is uniquely able to telemed” train has left the station. Everyone is telemeding now.

October 20, 2019: 500+ word Open Letter to Members of Congress by DPC Coaltion President asking for support and co-sponsorship of the The Primary Care Enhancement Act. Missing words: telehealth, telemedicine, virtual, telephone, phone, text message, text, SMS. March 26, 2020: DPC Coalition laments exclusion of the bill from CARES despite being sold as “meansContinue reading “The “DPC is uniquely able to telemed” train has left the station. Everyone is telemeding now.”

Pandemic effects on DPC enrollment

Possibilities to think about: DPC members who lose employer coverage will have the ability to go to ACA-compliant marketplace plans. Many of these will reach the low income levels at which ACA provides robust cost-sharing reduction is available. The relative desirability of DPC will fall. Some DPC members who lose income will become Medicaid eligible,Continue reading “Pandemic effects on DPC enrollment”

Direct Primary Care & COVID-19: some takes on Dr. White’s piece on dpcalliance.com

Update 4/22/2020. This one was mostly reactive to Dr White’s DPCAlliance.com essay on DPC and COVID-19. That was dated 3/19/20. I wrote this mostly in reaction to unseemly opportunism, not so much by White as by Flanagan and Springer as discussed. In retrospect, what DPC Coalition tried to do here looks almost pathetic. Expressly pitchingContinue reading “Direct Primary Care & COVID-19: some takes on Dr. White’s piece on dpcalliance.com”

Dr Priceline’s downstream cost reduction plan cannot simply be scaled up.

Dr. Lee Gross of Epiphany, a direct primary care leader, brags about the great discounts he gets for his patients on downstream procedures like advanced radiology. And, specifically, he proudly lets us know that a big part of this involves accessing advanced equipment during slack hours. This is, of course, the same strategy by whichContinue reading “Dr Priceline’s downstream cost reduction plan cannot simply be scaled up.”

I actually hope that many doctors who have engaged in policy advocacy were blinded by ideology, or simply lying.

I see so much bad analysis and arithmetic in policy advocacy by MDs, I have to hope that it’s a result of ideological blind spots, or even outright lying. I am frightened by the principal alternative explanation: that one can too easily become an MD despite the lack of basic analytical or arithmetic skills.

Making cost reduction claims more honest and helpful to decision-makers — random thoughts.

Claims of cost reductions need to look comprehensively at all costs. Consider this chart from an Iora presentation of some years ago. The net drop in spending would look a lot bigger if prescription drugs (the green bar) were not part of the picture. But, a lot of how primary care, direct or otherwise, worksContinue reading “Making cost reduction claims more honest and helpful to decision-makers — random thoughts.”

DPC and Medicaid expansion politics.

DPC docs uniformly recommend that their non-indigent patients have wrap-around insurance coverage. But for indigents, particularly for what are known as “Medicaid expansion adults” too many DPC docs are willing to push their state for an indigents’ program heavy on direct primary care coupled to, at best, skimpy coverage of downstream costs. They’re eager forContinue reading “DPC and Medicaid expansion politics.”

A moment of clarity about selection bias – at a DPC summit.

At 2019 Summit, Mike Tuggy, MD, FAAFP, presented this: What Have Primary Care Practices Provided to Employers Who Invested in Primary Care? The Results Speak for Themselves–Reports from Across the U.S. His presentation began with high praise for Qliance and others. He suggested that these models might be used to entice employers into a DPCContinue reading “A moment of clarity about selection bias – at a DPC summit.”