Thursday, February 21, 2008

Senate Hearing Links Physician Payment Rates to Primary Care Shortage

Several witnesses testified before a Senate committee on Feb. 12th that our nation's health care system continues to undervalue primary care services, and that this is leading to a skewed physician payment structure that is rapidly creating a shortage of primary care physicians throughout the nation.

Amazingly, although he agrees with and understands the data, the governments spokesman on this issue reaches an illogical conclusion, however. "When I say primary care services are undervalued, that does not mean that just increasing the prices paid to primary care is the solution," said Bruce Steinwald, director of health care for the United States Government Accountability Office, or GAO, during testimony before the Senate Health Education, Labor and Pensions Committee. "As you are well aware, we face unsustainable trends in the Medicare program and in the health care system as a whole. And, just as payment incentives are misaligned in primary care, they are misaligned in specialty medicine as well."

Yes, that is all true, I guess, but retaining primary care physicians will involve paying them more!

Medicare operates under a fee-for-service system, which rewards doctors based on the volume of services they provide. Medicare is the prime example of "how the system undervalues primary care services," and this discourages medical school students from pursuing a career in the primary care field, and causesthose in practice to restrict who they will see and retire early. These payment disparities have been exacerbated by technological improvements that allow subspecialists to provide more procedure type services in a shorter period of time, which leads them to an increase in payments and income, making these specialities more attractive career options for medical school students. In contrast, primary care physicians rely primarily on face to face time during office visits for their income. This means their ony option to be "more efficient" is to reduce time with their patients, which leads to rushed care and compromised quality.

I agree with the director, when he said, "This undervaluing of primary care services appears to be counter productive given the vast literature describing the relationship between health care costs and quality".


Erin said...

The other part often overlooked is that we don't want to encourage physicians to increase treatments, when the onus should be on preventative medicine and managing chronic illnesses/diseases. Preventing the need for extensive treatments in the first place is a more effective strategy... and yes, that WILL mean paying primary care physicians more to increase the quality of that care!

Anonymous said...

Respectfully, that is not Obama's proposal. If you are at all interested to challenge your prejudice, I have links on my blog to a review of his plan, the plan itself, and an article from the Wall Street Journal, "The Quality Cure" , which explain why I believe you are not understanding the proposal and objectives. I at least want ou to disagree with the actual intent, and not the Republican sound bites! I care a lot about this, because I see people ever day that are casualties of our dysfunctional health care non-system and I understand how change could be helpful.

Dr. Lynch, Referring to you reply to me. I object to the insinuation in your comment that I am prejudiced, in a bad way, against Mr. Obama. I am not. I am an (I) who did not vote for Mr. Obama or Mr. McCain the general election because I disagreed with 95% of Mr. Obama's policies and 85% of Mr. McCains. I did, nonetheless, vote for Mr. Obama over Mrs. Clinton in the Virginia primary because I saw his health care plan less radically socialist than her 1990's plan which I was sure she would bring back in good time.
Back in 1994 I had a hip replacement due to a childhood football injury. Part of the calculus in my having it done then rather than wait a couple of years was the socialized medicine she was preaching which was far left to that of her putative husband. Her model, built on that of Canada and England, was that which put hip replacements in the "boutique" category rather than the pain-relieving necessity they are. I did not, and do not, want my hip replacements rationed or have a government agency decide who would do my surgery. I'm sure former President Clinton's by-bass was not done by someone off a list.
Mr. Obama's plan is not as radical as Mrs Clinton's was back then but it is sliding in the direction of the same socialized medicine model. Mr. Obama's plan predicts great savings from some administrative adjustments in the system. The savings will then make insurance more afordable thus bringing everyone into the system. This will fail for a number of reasons, not the least of which is that everyone does not want to buy health insurance. There is a large percentage of 20-40 year old who are "healthy" and would prefer to pay a BMW lease than a Ford Focus lease. Once this system fails, as it is in Mass slowly, the move to socialized medicine will begin.
I will have had my revision and my replacement on the other side by then hopefully.