Primary Care at Risk

Edition: March 2006 - Vol 14 Number 03
Article#: 2354
Author: Repertoire

Primary care is at grave risk of collapse. If comprehensive reforms are not put into place soon, within a few years, the United States will lack enough primary care physicians to take care of an aging population with increasing incidences of chronic disease.

That’s the outlook of the American College of Physicians, an association representing 119,000 internal medicine physicians and medical students. The association sounded the warning in a report issued Jan. 30, titled “The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation’s Health Care.”

“I know from my decades of work as an internist specializing in general medicine that a career in primary care can be both a rewarding and valuable pursuit,” said ACP President C. Anderson Hedberg, M.D., in remarks accompanying the report’s release. “I’m concerned that, for many of the young doctors I meet, the rewarding experience I’ve had in general internal medicine is out of reach. Medical students tell me that they just do not see a future in primary care.”

Dysfunctional payment systems

Topping the list of reasons why primary care may be in doubt are dysfunctional payment policies, particularly those of Medicare, according to ACP. In a nutshell, the feds reimburse procedures heavy on technology, but under-value office visits and other evaluation and management services provided by primary care physicians, the association alleges.

“Medicare should begin paying physicians more for the time spent with patients evaluating and managing their care; for investing in health information technology to improve quality and for helping patients with chronic illnesses manage and control their diseases to avoid later complications,” says the association in its report. Furthermore, internists should be paid for e-mail and telephone consultations, as well as time spent coordinating a patient’s care with other healthcare professionals and family caregivers.

ACP envisions a new way of financing and delivering primary care, which it calls “advanced medical home.” The advanced medical home would be a physician practice that provides “comprehensive, preventive and coordinated care centered on their patients’ needs, using health information technology and other process innovations to assure high quality, accessible and efficient care,” says the association. Practices would be certified as advanced medical homes, and certified practices would be compensated accordingly. In turn, these practices would be accountable for results based on quality, efficiency and patient satisfaction measures.

“The advanced medical home would be particularly beneficial to patients with multiple chronic diseases — a population of patients that is growing rapidly and that consumes a disproportionate share of health care resources.”

Editor’s note: Next month, Repertoire begins a three-part series on internal medicine and cardiology. Check the April 2006 issue for further discussion of the ACP report.