Chickens coming home to roost

Roosting ChickensDr. Peter Beilenson writing in The Baltimore Sun reports on the so-called “menace” of boutique medicine:

A new and disturbing trend in the medical field is gradually eroding access to primary care physicians: boutique medicine.

In medical practices that “go boutique,” a provider’s patients are asked to pay an annual fee…

Unfortunately, the majority who don’t want to pay this retainer, or can’t afford it, lose the ability to see their trusted primary care provider. This sounds, at first, like a mild inconvenience at worst; after all, these patients are generally fully insured. The problem is that in more and more areas of the country – including much of Maryland – the number of primary care doctors is quickly shrinking. And because the typical practice of 3,000 patients decreases to 500 patients once it has gone boutique, for the deserted patients of boutique medical practices, having health insurance coverage does not equal access to health care.

This “new and disturbing trend” is rooted in an old and disturbing trend: not paying primary care physicians enough money to entice them to remain in practice and to incentivize medical students to pursue careers in primary care.  As usual, to state the problem is to state the solution:

To counter this problem, insurers must do two things: increase reimbursement rates to primary care doctors and drastically streamline their administrative requirements.

Medicare also must address the problem. Because most private insurance reimbursement rates are tagged to what Medicare pays for that service, Medicare can help push private insurers by increasing primary care reimbursement rates too.

I think that is what we will see happen in the years to come.  Unfortunately, we’ll have to live with the consequences of not having done this 20 years ago until and for some time to come after American health care re-embraces primary care.

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