Harris to Daschle: Money, Tech Support for Primary Care
Dr. Jeffrey Harris, president of the American College of Physicians, has written a letter to Department of Health and Human Services Secretary-designee Tom Daschle. Dr. Harris’ prescription for a primary care renewal includes more money and technology:
Providing funding to Medicare to implement a 10 percent payment bonus for all services provided by primary care physicians…The stimulus package could require that CMS initiate the bonus payments no later than June 1, 2009 and continue them for the next eighteen months.
Provide technical support and funding to help primary care practices, especially smaller ones, acquire health information technologies that have the functions needed to become Patient-Centered Medical Homes (PCMHs).
As with so many proposed remedies to the primary care shortage, I have mixed feelings about this. I applaud the fact that we are finally acknowledging the magnitude of the primary care problem and are hearing ideas to return American medicine to some semblance of sanity. But I do see some problems with Dr. Harris’ proposal:
Many primary care offices have either opted out of Medicare or are still seeing their existing Medicare patients but are not accepting new ones. The problem of Medicare patients being unable to find physicians to take them has appeared on both this and other blogs as well as in the mainstream media. Dr. Harris acknowledges this as well:
It is important to recognize that by itself, a 10 percent increase in Medicare payments for primary care will not bring primary care earnings up to the point where they are competitive with other specialties, given the wide gaps that currently exist. But it would help struggling primary care practices keep their doors open for the next 18 months.
So struggling primary care practices can shut down a year and a half later than they otherwise would? I somehow doubt this will cause medical students to start migrating back from the specialties to primary care. How about Loser Pays for primary care? How about government deregulation of medicine? I think we should make running primary care practices less costly as well as making them more lucrative.
As to health information technology (HIT), the perennial panacea to all health care problems, the technology is simply not refined enough or cheap enough for widespread implementation. It’s going to take less expensive, more user-friendly, more interoperable software packages before most medical practices can effectively integrate HIT.
We can at least hope that we are witnessing the first steps in a long journey back to the “re-primary care-ization” of American medicine.