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Fixing Up Primary Care: Is Anyone “Home?”

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By John Henning Schumann, M.D.

The Patient Protection and Affordable Care Act (aka “Health Care Reform”) signed by President Obama in March will revolutionize primary care in the United States. By 2014 tens of millions of uninsured people will “enter” the system by being granted insurance, either through expansion of the Medicaid program or through mandated purchasing of insurance via state pools or the private market.

This alone will have a profound impact, straining the capacity of our already frayed system. Therefore, embedded in the law are funds to encourage growth and improvement in primary care: Incentives to encourage graduates to enter primary care fields (family medicine, internal medicine, and pediatrics) and practice in underserved areas (through scholarships and loan forgiveness), and money to re-format the way that primary care is practiced and paid for. Read more »

*This blog post was originally published at ACP Internist*

“E-Visits” With Patients: For Greedy Doctors Or Not?

Dr. Wes (a cardiology blogger whom all should read) wrote a very compelling post about technology and the bondage it can create for doctors:

The devaluation of doctors’ time continues unabated.

As we move into our new era of health care delivery with millions more needing physician time (and other health care provider’s time, for that matter) –- we’re seeing a powerful force emerge –- a subtle marketing of limitless physician availability facilitated by the advance of the electronic medical record, social media, and smartphones.

Doctors, you see, must be always present, always available, always giving.

These sound like dire words, but the degree to which it has resonated around the Web among doctors is telling. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

What A ’68 Chevy Impala Can Tell Us About Primary Care

When I was a much younger man I had a 1968 Chevy Impala. I loved its V-8 engine and spaciousness, but I paid a steep price for it. It consumed gas like a drunk on a binge. It was prone to breakdowns, usually in the left lane of a busy highway. Even as it consumed my limited financial resources, I couldn’t count on it to reliably get me to where I wanted to be. Yet I held onto it. One day, though, its transmission gave out, and I finally had to resign myself to buying a new, more reliable, more modern, and efficient vehicle. Yet to this day, I miss my clunker.

I am reminded of this when I think about the state of primary care today. Many of us are attached to a traditional primary care model that may no longer be economically viable — for physicians, for patients, and for purchasers.

We hold onto a model where primary care doctors are paid based on the volume of visits, not the quality and value of care rendered. We hold onto a model where patient records are maintained in paper charts in voluminous file folders, instead of digitalizing and connecting patient records. We hold onto a model that generates enormous overhead costs for struggling physician-owners but generates insufficient revenue. We hold onto a model that most young doctors won’t buy, as they pursue more financially viable specialties and practices. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Why Patients Are Unsure Of The Primary Care “Medical Home”

Say the words, “Patient-centered medical home,” and you’re bound to get a variety of opinions.

On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money. And that’s not good news for its advocates, who are pinning primary care’s last hopes on the model.

Medical homes hit the mainstream media recently, with Pauline Chen focusing one of her recent, weekly New York Times columns to the issue. She discussed the results of a demonstration project, showing some positive results. Read more »

*This blog post was originally published at KevinMD.com*

Transitioning Primary Care To “Patient-Centered” Team Care

While the “patient-centered medical home” may be a good idea, it needs a better name. It sounds like a hospice, reports surgeon and columnist Pauline Chen, M.D. She outlines the initial experiences of practices making the transition to the new practice model.

One problem uncovered by pilot projects is that doctors in transition to the practice model have to spend inordinate amounts of time of things other than patients. And while the patients want and welcome the changes, they face a learning curve too, as they move from seeing just the doctor to working with a team of providers for their care. 

Physicians suggested using resources from the Patient-Centered Primary Care Collaborative, a collaborative group set up to help offices make the transition. (New York Times)

*This blog post was originally published at ACP Internist*

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