We are seeing the newest CMS edition of neo-innovative hyper-modernization™ offered by the visionaries of the future – the Comprehensive Primary Care Plus model, which has a five-year funded initiative to do things.
Primitive cultures would often, in the twilight of their days, become fixed in a certain rut, offering a stale and repetitive set of impotent answers to problems – answers which were tightly constrained into a small bubble of thought, locked into liturgical formulas and fragile conception of the world. We should be proud to discover that this tendency is not a laughable habit of stick-worshipers, but survives to this day in the Holy City of Washington.
The stick-worshipers would re-invent what was actually a near-identical repetition of old ideas which did not change Reality in the slightest bit. They would vary the incantations to appease the gods in some novel and innovative way – a change in sequence, a different intonation. We do not know the various ramifications and paths exactly – all of these cultures have passed into the dust long ago.
Our cult takes something that works in a very unsophisticated way – say, direct primary care – and decorates it with all manner of ornateness, and brings unwanted characters and choruses into the great opera that they have made out of a simple song. We can do this, we say, because we can do this. Thus it falls back to the instinctive human error of hubris – the arrogance of man reaching out beyond his capacity. (and woman too, let’s be fair.) See CMS Announces New Model for Primary Care
Under Track 1, physicians will get paid on a fee-for-service basis, but will also receive a monthly per-patient fee averaging $15 per beneficiary per month for managing each patient’s care.
Under Track 2, physicians will be paid through a combination of fee-for-service and something called a comprehensive primary care payment (CPCP). In this model, physicians will get the CPCP — based on their expected evaluation and management claims — and will then receive reduced fee-for-service payments. Track 2 practices also will receive a care management fee averaging $28 per beneficiary per month — including a $100 care management fee for the most complex patients.
With Track 2, “Doctors will be given more freedom to design the type and amount of care that best meets the needs of their patients,” said Conway. “If telehealth makes sense, they can do that. If they think longer visits are needed because of the complexity of a patient, they can do that. This initiative will also make it easier for doctors to communicate with each other and have all the information they need. They will know [what treatments have] worked or failed in the past; they will be able … to get better support from nurses, specialists, and others on the patient’s care team.”
In the ritual of incantation, vague and indefinite things, occult gods and half-baked concepts are thrown into the chant. As the purpose is mystical, there is no need to restrict one to rational principles that can be logically explored to increasing detail.
The dog-man god is simply the dog-man god, there is no need to purport what its name is, or how it speaks.
There need only be phrases flung into the incantation – more freedom care needs patients; telehealth longer complexity communicate information, support patient care team, certified electronic health record technology, electronic clinical quality measures practice level. Verbs may be sprinkled here and there to make the chant meaningful, at least in a grammatical sense.
The cult has many aspects, many gods – the gods of industrialization, modernization, technocracy and homogeneity. Like many cultic worlds, there is no tolerance of any suggestion that the cult is mostly nonsense.
The Heads of Easter Island looked out upon an impoverished desert of an island for hundreds of years, until it was discovered, sparsely populated, by the Europeans. The indigenous people had built an advanced and sensible culture that squandered a tremendous amount of effort desertifying their island to erect statues that spoke of bounty, plenty and prosperity. Perhaps then did not realize that they were fools at the time, or even fools long after. Perhaps they were still waiting for the prosperity when the Europeans sailed from the Edge of the Known World to their island.
But we know they were not primitive and ignorant people. They are merely us, but upon an island.