Lack of primary care costs money

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Category : Medical Rants

Frequent readers know that I have decry our payment system and the subsequent negative impact on primary care.  This article puts numbers on my opinions – Health Care Wastefulness Is Detailed in Studies

The study is the first to quantify the problem, according to Dr. Stephen R. Pitts, the lead author and an associate professor of emergency medicine at Emory University. Examining records of acute care visits from 2001 to 2004, the researchers concluded that 28 percent took place in emergency rooms, including almost all of the visits made on weekends and after office hours.

More than half of acute care visits made by patients without health insurance were to emergency rooms, which are required by federal law to screen any patient who arrives there and treat those deemed in serious jeopardy. Not only does that pose a heavy workload and financial burden on hospitals, but it means that basic care is being provided in a needlessly expensive setting, often after long waits and with little access to follow-up treatment.

“More and more patients regard the emergency room as an acceptable or even proper place to go when they get sick,” Dr. Pitts said, “and the reality is that the E.R. is frequently the only option. Too often, patients can’t get the care they need, when they need it, from their family doctor.”

The new federal law is expected to bolster primary care by increasing reimbursement for practitioners, luring students into the field with incentives, expanding community health centers and encouraging new models known as accountable care organizations and patient-centered medical homes.

The authors warn that it might not be enough. “If history is any guide, things might not go as planned,” they wrote. “If primary care lags behind rising demand, patients will seek care elsewhere.”

Only a politician would believe that the new federal law will bolster primary care.  The payment adjustments are relatively squadoosh. I fear that policy wonks and politicians remain ignorant of primary care.  We need a more realistic appraisal and solution than we have received thus far.

We live in a free society.  Physicians have freedom to choose their career.  We have the freedom to modify our careers over time.  The main reason to do primary care in 2010 is the love of the profession.  Unfortunately, our payment system (and overhead requirements) too rapidly frustrates many primary care physicians.

Investing in primary care saves money and improves health care quality.  We are not investing enough in primary care.  Our health care system therefore is wasting money.  But try to explain that to wonks, politicians and the Congressional Budget Office.

Comments (4)

As long as we have a system driven by production instead of quality and value, there will be little that will change.  There are too many special interests feeding at the trough that will opose any and all attempts to provide cost effective medicine.  Primary care done right would limit this feeding frenzy and that is something the big money does not want to see.

Part of the new healthcare law is to raise primary care Medicare fees 10% from July 1 through sometime in Nov, 2010.  In my area, the average level three visit has gone up $7, making Medicare my second best payor at $67 per level 3.  I wrote to all my contracted insurance companies, including ones that lowered my new patient outpatient fees 3 years ago and asked  them to meet Medicare rates.  So far only one company is above Medicare, as it was prior to our 2010 raise.  Currently all my other private plans are on Medicare fee schedules that are 3-4 years old with a take it or leave it attitude in the one way negotiations.  This is despite more prior auths for MRI/CTs and mail order refill requirements to add to our abundant administration time.   

Lack of primary care?  Wait 'til 30 million more folks are on the insurance rolls. 

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