FROM THE MCMS BOARD PRESIDENT
“ O L D S O L D I E R S N E V E R D I E …T H E Y J U S T FA D E AWAY.” —General Douglas MacArthur in his April 19, 1951 farewell address to the U.S. Congress
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or my final column of the Maricopa Medical Society, I was asked to write an article on a subject I know next to nothing about: valuebased care. The reason for my ignorance on this topic stems back to 2006 when I changed my practice. I was tired of getting shellacked by insurance companies, so I lowered my fees and charged patients directly. I was most satisfied personally and professionally and did very well financially with that model of care. Indeed, many years ago, that is how care was provided to patients. This coming year will mark my 37th year of practicing medicine. Along the way I have seen many “plans” designed by bureaucrats to improve quality of care and at the same time lower costs. HMOs, PPOs, and other managed care plans have done little to improve care or lower costs. They have resulted in a clever ruse by Medicare and other carriers to transfer progressively more administrative costs to the practicing physician, while at the same time lowering physician reimbursement. In addition, these intrusions into the doctor-patient relationship certainly do not improve patient satisfaction. This is particularly the case these days with EMR’s: the physician interfaces with the computer screen more than the patient. There is no nice way to say it, but here is how I see it: Ironically, as medicine has realized tremendous scientific advances over the past few decades, these improvements have not been able to offset the selfdefeating lifestyle of most Americans. This continues to include poor diet, substance abuse, tobacco use, and inactivity. Along the way, we misplaced the value of preventative care. It is an incontrovertible fact that the more people placed in between the doctor and the patient, the higher the cost of care escalates. These administrative middlemen contribute nothing directly to patient care and are a large part of the healthcare economic burden we face as a society. It also appears to me that while our work as physicians has been devalued, the salaries of hospital, insurance, and pharmaceutical executives have grown higher than ever. I wish someone would 4
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tell me the value-added by these higher salaries to improved patient care. “Value-based care” is the new name for care previously delivered by HMO plans. It appears that IF you have a healthy uncomplicated caseload of patients, you are golden. If not, you must compromise in some way, and we all know what that means. Clearly, the most cost-efficient care that leads to the greatest patient satisfaction and the fewest unnecessary tests is the doctor-patient model. I have seen all the others come and go. I suspect “valuebased care” will realize a similar fate. It saddens me to see how medicine (and specifically the practice of medicine) has changed. It further saddens me to know that because of our apathy, we have allowed this to occur. I may be retiring from medicine in the next few years, and like the old soldier I will fade away, but you all know that what I say rings true. Thank you for the honor to have served as your President of Maricopa County Medical Society in 2021. I promise to remain involved and to help complete the work we promised earlier this year and to help MCMS grow. Respectfully,
John Prater, DO
Dr. Prater moved from Ft. Myers, FL to Phoenix in 2017 and shortly thereafter became a Director on the Board of Maricopa County Medical Society. He was active at the state and local levels of organized medicine in Florida for decades where he served in several physician leadership positions, including President of the Southwest Florida Psychiatric Society and President of District Eleven of the Southwest Florida Osteopathic Medical Society. He is a board-certified psychiatrist currently practicing at the Phoenix VA Medical Center.
