The great hope of the primary care initiative unveiled by the Trump administration this week is that it will finally pay doctors to use technology to stay connected to their patients and intervene before — not after — health problems arise.

The concept is simple: Front primary care doctors money to provide high-touch care to keep their patients healthy, instead of paying them to jam their calendars with so many in-person office visits that they can’t respond to emergent problems.

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  • No, the hope of the Trump administration is that P4P, which has been shown to WORSEN performance in cognitive work, will improve performance in cognitive medical work. (Google Ariely, cognitive reward) AND that ACOs, which have not succeeded in improving care or reducing costs, will do so if rewards/punishments for cognitive work are increased (more ACOs have dropped out of MCR programs each year, as more work costs them more money, and risks increase.)

    High functioning health systems are built on primary care, and invest 10-12% of total costs in primary care. Medicare now pays primary care about 2% of total costs; these programs might increase that to 4-5%, while imposing additional reporting costs and risks tied to events beyond the control of individual practitioners, who are very wary of taking on additional risk.

    Fifty years of payment policies destroying primary care have increased costs, worsened outcomes, and decimated primary care.

    It has been said that “Americans will always do the right thing…after trying everything else.”

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