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Primary Care Doctors: The 'quarterbacks' In A Value-based Care Playbook

The journey to value-based care, an alternative health care model in which doctors are paid based on the health outcomes of their patients, begins with the primary care physician.

"There is no question in my mind as it relates to the importance of the primary care doctor as the quarterback of patient care in any type of value-based model," said Kamal Jemmoua, CEO of Prominence Health, the value-based division of Universal Health Services. "But as we advance and see the maturation of the work we are doing in value-based care, we would be remiss if we didn't recognize that there are deep needs to engage specialists around condition-specific management."

Jemmoua shared his insights during "Using Data to Improve Provider Referrals and Increase Savings," a webinar sponsored by CareJourney and Fierce Healthcare.

"He Wanted Full Control"; Former Brigham Patient Details Pattern Of Isolation, Alleged Sexual Abuse By Doctor

BOSTON – A former patient of rheumatologist Dr. Derrick Todd agreed to speak with WBZ-TV on the condition of anonymity, as she shared intimate details of the alleged sexual abuse perpetrated by Todd for years.

Todd is being sued by at least 150 former patients in multiple lawsuits for the alleged abuse, and patients tell WBZ they have been interviewed by Boston Police as part of a criminal investigation – one police have not yet confirmed.

"It was a years long trajectory," the woman said. "He attempted to isolate me from multiple specialists."

She began seeing Dr. Todd in 2014 for severe onset rheumatoid arthritis.

"At the beginning it was all about reducing my inflammation levels and getting me on the correct meds. I felt better. I was grateful. And he seemed incredibly competent and caring," she said.

A few years into her treatment is where she says things started taking a strange turn.

Dr. Todd, a Brigham and Women's rheumatologist at the time, continued asking her if she wanted him to become her primary care provider.

"It was incessant," she said.

She said no, but eventually, after some time, her primary care doctor retired, and since he had asked so often, she transitioned to Dr. Todd for primary care.

"He was in many ways overseeing a great part of my general health care already," she said.

Shortly after he became her primary care provider, she says Dr. Todd told her he was also available to do gynecological care.

"He knew I had a long-standing gynecologist" with whom she had given birth to her two children, she explained to WBZ. "He knew of these relationships, but it didn't stop him from again, repeatedly mentioning, asking… And I said no."

Then she says, the pattern grew more concerning.

She says Dr. Todd cast doubt on her gynecologist's motivations, pointing out that —in his opinion, she says— they conduct exams for the money.

"The grooming had clearly already started now in retrospect," she said. "He already had me as his patient on multiple levels. He had already begun the process of isolating me."

Again, the pattern repeated itself. Her gynecologist retired, and because Dr. Todd had offered so many times, she signed on with him.

Now, Dr. Todd was rheumatologist, gynecologist, and primary care provider. "It was only Dr. Todd," she said.

At this point, she says, things took a dark turn. She says Dr. Todd told her he could only see her at the smaller Charles River Medical Center in Framingham, in the early hours of the morning, when little to no staff was present.

It was her first appointment at Charles River where she says she was physically abused during a routine pap smear.

"It hurt a lot," she said. "I was bleeding from the pap. It wasn't the pap itself that hurt. It hurt because he didn't use lubricant on the speculum… And that was the first time in all my decades that that has happened."

At a subsequent appointment, she says Dr. Todd offered a pelvic floor massage – a procedure usually performed by her physical therapist. However, this so-called massage was unlike any she received.

"It was not therapy of any kind," she said. "It was straight out intended for one purpose, and because I was brainwashed…" she didn't say anything.

It was only months later, when reading about a New York case of sex abuse by a doctor, that she says she realized what happened to her.

"He pillaged, he took, he took from me, he took from his colleagues," she said. "He wanted full control, and isolation."

Dr. Todd's attorney Anthony Abeln provided the following statement to WBZ.

"Due to privacy laws, Dr. Todd cannot comment on the care provided to any specific patient," it read. "However, over the course of his twenty year career in medicine, Dr. Derrick Todd has been recognized as a skilled and accomplished rheumatologist, internist, and primary care physician. He has been fully cooperative with all investigations, including the Board of Registration in Medicine, and is confident that when all the facts are considered – or even litigated – these allegations will be proven to be without merit. All of that will take place in the appropriate forums and not in the context of a media frenzy or a rush to judgment."

Charles River Medical Associates addressed the ongoing allegations in a statement to WBZ.

"We have been reaching out to patients and providing them with an opportunity to report any concerns they have about care they received from Dr. Todd. CRMA and Brigham and Women's Hospital are separate entities. At no time, up until and including his last day at our Framingham office on July 26th of this year, did we receive, nor were we made aware of any complaints from patients, staff, or any other physicians about inappropriate conduct by Dr. Todd."

The patient who spoke with WBZ says she now sees all female doctors by choice.

"It's incredibly refreshing to be treated by people so professionally," she said.

If you are interested in learning ways to advocate for yourself with medical professionals, WBZ spoke with ethics experts about ways to help yourself.

If you or someone you know has been a victim of sexual assault please visit the Boston Rape Crisis Center website, the RAINN website or the Mass.Gov website.

Half Of Primary-care Doctors In Survey Would Leave Medicine

By Val WillinghamCNN Medical Producer

(CNN) -- Nearly half the respondents in a survey of U.S. Primary care physicians said that they would seriously consider getting out of the medical business within the next three years if they had an alternative.

Experts say if many physicians stop practicing, it could be devastating to the health care industry.

The survey, released this week by the Physicians' Foundation, which promotes better doctor-patient relationships, sought to find the reasons for an identified exodus among family doctors and internists, widely known as the backbone of the health industry.

A U.S. Shortage of 35,000 to 40,000 primary care physicians by 2025 was predicted at last week's American Medical Association annual meeting.

In the survey, the foundation sent questionnaires to more than 270,000 primary care doctors and more than 50,000 specialists nationwide.

Of the 12,000 respondents, 49 percent said they'd consider leaving medicine. Many said they are overwhelmed with their practices, not because they have too many patients, but because there's too much red tape generated from insurance companies and government agencies.

And if that many physicians stopped practicing, that could be devastating to the health care industry. Dr. Gupta: Watch more on the looming doctor dearth »

"We couldn't survive that," says Dr. Walker Ray, vice president of the Physicians Foundation. "We are only producing in this country a thousand to two thousand primary doctors to replace them. Medical students are not choosing primary care."

Dr. Alan Pocinki has been practicing medicine for 17 years. He began his career around the same time insurance companies were turning to the PPO and HMO models. So he was a little shocked when he began spending more time on paperwork than patients and found he was running a small business, instead of a practice. He says it's frustrating.

"I had no business training, as far as how to run a business, or how to evaluate different plans," Pocinki says. "It was a whole brave new world and I had to sort of learn on the fly."

To manage their daily work schedules, many survey respondents reported making changes. With lower reimbursement from insurance companies and the cost of malpractice insurance skyrocketing, these health professionals say it's not worth running a practice and are changing careers. Others say they're going into so-called boutique medicine, in which they charge patients a yearly fee up front and don't take insurance.

And some like Pocinki are limiting the type of insurance they'll take and the number of patients on Medicare and Medicaid. According to the foundation's report, over a third of those surveyed have closed their practices to Medicaid patients and 12 percent have closed their practices to Medicare patients That can leave a lot of patients looking for a doctor.

And as Ray mentioned, med school students are shying away from family medicine. In a survey published in the Journal of the American Medical Association in September, only 2 percent of current medical students plan to take up primary care. That's because these students are wary of the same complaints that are causing existing doctors to flee primary care: hectic clinics, burdensome paperwork and systems that do a poor job of managing patients with chronic illness.

So what to do? Physicians don't have a lot of answers. But doctors say it's time to make some changes, not only in the health care field but also with the insurance industry. And they're looking to the new administration for guidance.

One of President-elect Barack Obama's health care promises is to provide a primary care physician for every American. But some health experts, including Pocinki, are skeptical.

"People who have insurance can't find a doctor, so suddenly we are going to give insurance to a whole bunch of people who haven't had it, without increasing the number of physicians?" he says. "It's going to be a problem."

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