Saving Primary Care

Physicians, nurse practitioners, midwives, physician assistants, nurses, medical assistants, - all of us work hard every day caring for people with huge needs that are poorly met by our dysfunctional system. We patch the holes as best we can with our caring and our sweat but the health care environment is in many ways toxic to us and harmful to our patients. Too much of our effort is diverted into the complicated red tape of “billing” or satisfying prior-authorization requirements documenting that our patients’ needs are real.

Policies are being crafted as solutions to the problems of US health care but those policies seem distant from our reality.

More people with health insurance may be a terrific improvement but what people really need is health care. The current rules make it so that many of us can’t possibly care for more people than we serve right now.
Health information technology can help us but most of what is currently in the market is too expensive and doesn’t even do what we need to care for our patients.
We want to demonstrate the quality of care we deliver but current measurement approaches require we divert even more time away from our patients to satisfy arcane rules and pursue trivia.

Current policies reward the wrong things:

We were trained to deliver effective care but are blocked by policies that reward volume of services rather than quality of care.
Our professional obligation to coordinate care is blocked by policies that punish us financially for doing this work.
Our ethical responsibility to care for all is thwarted by a system of policies that provides health care to some and not all.

Reward volume of services and procedures and you get volume and procedures. Establish rewards that ignore quality and quality will be ignored. Our system is perfectly designed to achieve the following results:

Low value care due to high cost and low quality
Poor health outcomes due to missed opportunities and weak prevention
Frustration and errors due to fragmented care

Effective primary care is the foundation of a high performing health system. High performing health systems get better care at less than half of what we spend per person in the US.

When people can say the following, they are getting effective primary care:

“I can get care from my primary care provider (PCP) when I need it.”

“I have a PCP who knows me.”

“My PCP takes care of most of my needs.”

“My PCP coordinates my care.”

The US needs effective primary care if it is ever going to have a high performing health system.

Provide us the resources to do our work well.
Remove the crushing burden of “mother-may-I” with insurance denial clerks so that we can provide care our patients need.
Stop the mindless and expensive complexity of paying for health care by counting procedures and visits.
If we are to report on quality, give us an approach that works and doesn’t break the bank or break our backs.

The US could have a high performing health system if it chooses. Policy makers who hear only from the usual cast of characters are not likely to propose real change. We can help them do the right thing for America if we keep them in touch with the front lines of care.