Secretary Sebelius and the Department of Health and Human Services (DHHS) should be commended for the immediate $250 million provisioning from the Prevention and Public Health Fund. Although this fund provides:
1. $168 million to train 500 new primary care physicians;
2. $30 million to encourage 600 nursing students to finish school and join the profession;
3. $32 million to create 600 new physician assistants;
it still may not improve the nation’s primary care “network.” The reality of the United States primary care network is there is no “network.” Adding more people (jobs) to an already uncoordinated, non-communicating system will not increase efficiency or the quality of care—it will only add to the complexity of the current environment and to the daily frustrations of the healthcare worker.
According to Landmark: America’s New Health-Care Law and What It Means for Us All, the workload of primary care doctors will increase by 29% in 15 years. In 2007, only 23% of internal medicine residents planned to enter primary care, down 54% from 1997.
The stark truth: in the medical community, primary care is more oft than not viewed as “the Lord’s work,” a “labor of love,” a thankless job where highly educated physicians (and practitioners) have to make dozens of follow-up calls, schedule treatments, run a practice, pay malpractice insurance, and try to figure out Medicare reimbursement rates. For a new physician, this reality is daunting and may possibly be the largest detractor to the pursuit of this career path for healthcare workers. Bottom-line, there is no George Clooney “marketing” primary care.
Researchers at the Center for Studying Health System Change examined the experiences of 2,284 physicians in Medicare’s fee-for-service program where each physician treated on average, 264 Medicare patients. The study found that for every 100 patients treated, a single physician may need to contact 99 other physicians in 53 practices to garner a complete “patient picture,” (?!?!?!?).
The $11 billion earmarked for the nation’s primary care “system” must consider the coordination and communication of practitioners in their respective communities. Technological investments must be made, at the community level, to lessen the administrative burden of these valued practitioners. In a Harvard School of Public Health study, of 2,135 physicians (all not primary care docs), 1 out of 3 physicians said they experienced increased administrative burden after the Massachusetts healthcare law was implemented. In general, recommendations to consider in improving the nation’s primary care system should include:
1. Subsidies for malpractice insurance for new primary care practitioners.
2. Improve the coordination of Medicare billing at the local level. Reduce reimbursement times from clinic billing to accounts receivable.
3. Expand the role of physician assistants and nurse practitioners in the medical practice. They have brains and experience; they should be put to good use.
Until the family practice joins the 21st century in its ability to communicate and connect with patients, providers, and provider entities in a medically safe and efficient manner, we can only expect the same.
