I have addressed -- in the context of medical malpractice claims -- the importance of changing the reimbursement system to provide better compensation for primary care doctors. "The first line of defense in proper patient care is the primary care system, yet this portion of health care delivery is systematically undercompensated and undervalued in the medical payment spectrum. We have relegated primary care doctors to a triage function, requiring them to see a large number of patients in a short period of time."
Here's another reason. A story in today's Boston Globe by Liz Kowalcyzk cites a study of crowding and overuse of emergency rooms in Massachusetts. Dr. Peter Smulowitz, the study's author and an emergency room physician at BIDMC, concludes that the problem stems at least in part from the same problem: "We have to pay primary care doctors what they're worth and increase the network for primary care from doctors and other providers."
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7 comments:
As a cancer patient, and also as a health care provider and advocate, I stress the importance of a PCP. My PCP is my safety net. He will advocate for me even though I am beyond his specialty.
He is also ready to collaborate care among specialists on my behalf for the best possible outcomes. Treat those PCPs nicely, people.
As the author of the preliminary study cited, let me just modify what Paul said in his blog. The study doesn't document crowding or "overuse" of the ED. What it shows is that visits across the state continue to climb, while visits by the uninsured decreased as a consequence of health care reform. This should serve to remind policy-makers that the uninsured are not the cause of ED crowding. However, there are many reasons people use the ED, so what I don't want to come out of this article is the misperception that if we just fix primary care, we won't need the ED any longer. Clearly we know that is not the case. With an aging and more complex patient population every year, the ED remains essential for our medical safety yet. But the article is absolutely right in saying that primary care is undervalued. That we've known for years.
It would be interesting to know what percentage of the patients visiting ER's were "frequent flyers", and whether their frequent flying was due to a chronic condition for which they do not receive adequate monitoring; or whether they are just in the habit of going to the ER for every little problem. I suspect there is some of both, but it seems that further drilling down of the data may yield more information pointing toward a course of action.
(Having said that, I have not read the study directly.)
nonlocal MD
Is Dr. Smulowitz's study available anywhere yet? I would love to read more about his findings.
The data was preliminary data presented at a non peer review conference (data was only collected within last few weeks), so it is not published yet. We are certainly working quickly to put more hospitals into the data set and publish something on this ASAP, so stay tuned. If anyone has particular questions about it I am happy to comment.
It is not enough just to pay PCP's more. Specialists have to accept their role, which means accepting guidance from them.
From personal experience, I've found that the patient can do that. As an ambulatory patient, I accept drug recommendations from specialists, but prescriptions only from my PCP.
Well, there are probably not going to be many new primary care practices opening in Boston. More likely is that primary care residency graduates will look at strong multispecialty medical groups and IPAs. Hospitals probably need to be willing to enter into full risk contracts involving strong physician group partners to enable good primary care to be more fairly compensated through internal group mechanisms. Full risk enables the movement of resources from expensive episodic care to preventive care. This can be a hard step for traditional hospital administrators to take...
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