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Preventive Care Can Keep You Out Of The Hospital

In a recent study conducted by the Agency for Healthcare Research and Quality (AHRQ), it was argued that better primary care could prevent 4 million hospitalizations per year.  This staggering potential savings – on the order of tens of billions of dollars – seems like a good place to start in reducing some of the burden on the healthcare system (and reducing unnecessary pain and suffering).  I interviewed Dr. Joe Scherger, Clinical Professor of Family & Preventive Medicine at the University of California, San Diego School of Medicine (UCSD) and member of the Institute of Medicine, to get his take on the importance of prevention in reducing health costs.

Dr. Val:  What do the AHRQ
statistics tell us about the role of primary care in reducing healthcare


Primary care works with the
patient early in the course of illness, maybe even before it has developed, such
as with prehypertension and prediabetes.  Primary care focused on prevention
with patients keeps people healthier and out of the

Dr. Val: What can individual
Americans do to reduce their likelihood of having to be admitted to the

Prevention begins with the individual,
not the physician.  60% of disease is related to lifestyle.  Bad habits such as
smoking, overeating, not being physically fit, and stress underlie most common
chronic diseases.  If Americans choose to be healthy and work at it, we would
save tremendously in medical expenses.

Dr. Val: Are there other studies
to suggest that having a medical home (with a PCP) can improve

The medical home concept is new and lacks
studies, but the work of Barbara Starfield and others have confirmed the
importance of primary care and having a continuity relationship with a primary
care physician.  The more primary is available, the healthier the population.
The opposite is true with specialty care.

Dr. Val: Why did the
“gatekeeper” movement (promoted by HMOs) fail, and what is the current role of
the family physician in the healthcare system?

“gatekeeper” role failed because it restricted patient choice.  Patients need to
be in control of the health care, which is what patient-centered care is all
about.  HMOs put the health insurance plan in charge, something which was hated
by patients and their physicians.

Dr. Val: In your work with the
IOM (specifically in Closing the Quality Chasm) did the role of primary care and
preventive medicine come up?  If so, what did the IOM think that PCPs would
contribute to quality improvement in healthcare?  Did they discuss (perhaps
tangentially) the cost issue (how to reduce costs by increasing preventive

Just before the IOM Quality Reports
came out, the IOM did a major report on the importance of primary care.  The
importance of primary care and prevention are central to improved quality.  In
the “Chasm Report”, the focus was more on the patients taking greater charge of
their health care, and the realization that primary care is a team effort, and
not just a role for physicians.  The reduction in costs comes from making health
care more accessible (not dependent on visits) through health information
technology and the internet.  Preventing disease, and treating it early when it
comes, are the keys to quality and cost reduction.  Revolution Health is a
vehicle for this, consistent with the vision of the “Chasm Report.”

Dr. Val: How can patients be sure that they’re getting the best primary care?

First take charge of your
own primary care.  The traditional patient-physician relationship was, “Yes
doctor”, “Whatever you say doctor”.  Your care would be limited by the knowledge
and recall (on the spot) of your doctor.
Much better is a “shared care” relationship with your primary care
physician and team.  After all, the care is about you.  Be informed.  Make your
own decisions realizing that the physician and care team are advisors, coaches
in your care. You may agree with them, or disagree and do it your way.  By
having your own personal health record and being connected to resources like
Revolution Health, you are empowered to get the care you want and need.
Finally, choose your primary care wisely.  Not just anybody will do.  Your
primary care physician is as important a choice as your close friends.  You need
to like and trust this person.  Have a great primary care physician who knows
you and cares about you and your health care is in real good shape.  But, no
matter how good she or he is, you still must take responsibility for your care.

This post originally appeared on Dr. Val’s blog at

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4 Responses to “Preventive Care Can Keep You Out Of The Hospital”

  1. Dr Rob L says:

    Amen, Amen, Amen.  Did I say Amen?

  2. Anonymous says:

    Thank you for raising this issue.  Many healthcare organizations are working to implement the medical home model, although many are not familiar with this concept.  When HIN surveyed our audience — healthcare executives — many respondents confused it with a physical structure.  We have a resource that covers funding and implementation hurdles of the medical home concept, successful methods for identifying members and redesigning office practices to move toward an advanced medical home model.

  3. vermont 1 says:

    I agree with the above.Our rural practice changed to open access,2 years ago,and our hospitalization rate has markedly decreased . We are persuing other chronic care initiatives at this time. Even after 30years in practice,its never to late to change. A side benefit is our third party payors are considering increasing our office reimbursements,due to our lower hospitalization rates.

  4. ValJonesMD says:

    That’s great news, Vermont 1!  Keep up the good work… glad to hear that your office reimbursements are increasing too.  I sincerely hope that there will be a nationwide movement towards preventive care, with incentives to PCPs rather than proceduralists. 

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