Episode 045: Why Carrots & Sticks Won't Work with Doctors. A Discussion with Dr. Ryan Neuhofel

One of the great challenges to those paying for our health care today is determining who is high quality and poor quality, who is truly expensive or inexpensive, and who is doing the right thing. Unfortunately, the payers in medicine are oftentimes not the patients or their families but third parties either in commercial insurance of government insurance like Medicare and Medicaid. Since the person receiving the care is not directly paying for the service, administrators in an office somewhere have to make the determination of how to pay without experiencing the care and know whether the physician was providing the right care.

In order to find some efficient and objective way of determining the level of care, these payers have created a system of quality metrics and goals for their physicians to meet. They achieve this through the use of carrots and sticks – either financial rewards to achievement or reductions in pay if certain metrics have not been met. But this way of meeting goals, determining the goals, and paying for health care is all wrong says my guest, Dr. Ryan Neuhofel.

Dr. Neuhofel is a family medicine physician from Kansas who wrote a piece describing the pitfalls of insurance companies and the government trying to create metrics for best care. The problems with using these tactics are many.

The goals are often wrong. Over 80% of the goals set by the payers turn out to not be validated after more scientific inquiry occurs wasting a lot of resources to gather useless information.
Collecting the information required is expensive. The time, software, and equipment to gather the information or demographics or metrics required by the third party payer has been well documented to be overly burdensome and expensive for practices. Oftentimes, the gathering of the data is so expensive that private practices have to join larger health organizations to go out of business.
The motivation is all wrong. The motivation of withholding payments or enhancing payments for reaching certain thresholds in the population of your patients doesn’t work. All physicians want to do a good job maintaining the health of their patients. It is rare that they look to provide suboptimal care – nor should they. Therefore, enhancements will rarely produce meaningful results except to frustrate physicians by requiring the accumulation of a lot more data.
We need to focus on patients not populations. Although payers see only the forest and not any individual trees when it comes to their gigantic pool of patients, the physician treats people one at a time. They have a much better handle on the lives of the patients and can then work to achieve the patient’s goals for their life and health.

Ryan Neuhofel, DO — Dr. Ryan Neuhofel is a family medicine physician who owns NeuCare in Lawrence, KS. He is the president of the Direct Primary Care Alliance and is a leading advocate for the direct primary care model of medicine.

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show notes

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NeuCare: Dr. Ryan Neuhofel’s practice website.

@NeuCare: Where Dr. Neuhofel twitters.

DPC Frontier Mapper: If you’re looking for a DPC practice or want to add yours to this growing list. This is one of the biggest directories.

DPC Alliance: Dr. Neuhofel is the president of the Direct Primary Care Alliance which advocates for physicians to adopt the direct primary care model of delivering care.

Policymakers Put Down Your Carrots and Sticks. They Will Not Work.: Dr. Neuhofel’s written piece that we discussed during the show

Episode 002: My discussion with Dr. Amat about what DPC is and why she chose it.

Episode 011: Dr. Michel Accad describes why it is critical to focus on individual patients and not whole populations.

Episode 034: Dr. Lee Gross explains how he will use direct primary cost to control the cost of care and put physicians first as leaders.

Memorial for Andy Larson: This is the donation link to honor Andy’s death with the Grand Rapids Choir of Men and Boys where he blossomed and served as a head chorister.

YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page.

Patreon – Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.

Episode 045: Why Carrots & Sticks Won’t Work with Doctors. A Discussion with Dr. Ryan Neuhofel

Episode 045