You unlock this door with the key of imagination

The Twilight ZoneSubmitted for your approval…

A primary care physician who thinks Dr. Jonathan Glauser has a point!  And that poor primary care reimbursement isn’t all that related to the interests of patients!  At the sign post up ahead, your next stop…the Disease Management Care Blog.  Here’s some of what Dr. Jaan Sidorov had to say:

[Regarding the] letter [from the American College of Physicians]…sent to HHS Secretary-designee Daschle…

The letter recommends that another ‘stimulus package’ be created that…increases Medicare payments for primary care physicians (PCPs) including a 10% payment bonus over 18 months and…provides incentives (grants, interest free loans and tax incentives along with technical support) that increase PCP adoption of health information technology (HIT) as part of a broader effort to promote the Patient Centered Medical Home.

The DMCB understands why its ACP colleagues believe that a key ingredient for health reform is physician payment reform. It’s uncomfortable, however, with the mercenary tone of the letter. While primary care physician income has serious problems, the ACP letter above is muddling the patients’ well being with its physician-members’ economic interests.

As I posted earlier, I’d like to see some progress toward making running primary care offices less costly through tort reform to lower malpractice insurance and a general deregulation of the health care industry by the government rather than simply a primary care “bailout”.  I’ll admit that a 10% payment bonus over 18 months doesn’t constitute much of a long-term solution, but drawing a relationship between the “patients’ well being” and the ACP’s “physician-members’ economic interests” is not “muddling”.  As the Massachsuetts experience with expanding health care coverage without simultaneously greatly expanding primary care demonstrates, when you spend a generation underpaying primary care physicians to the point that med students stop going into primary care even as existing PCPs retire, quit, or cut back on hours, you pay a heavy price, as do patients.

Compared to the pain from the widespread mortgage foreclosures, lay-offs and vaporizing retirement funds, even the worst-off primary care physicians have little to complain about.

True, but what of it?  Compared to a fellow who just got hit by a bus, the worst-off primary care physicians have little to complain about.  But if we start comparing well-reimbursed specialists with solvent practices to primary care physicians, the latter do have something to complain about.  As do, to take just one example, Medicare patients who can’t find a primary care physician.

Dr. Sidorov makes some good points and perhaps gives us an admonition that whatever grievances primary care physicians have, a certain measure of PR skill and diplomacy will be needed to get those grievances addressed.  But the simple fact is primary care is both very important and very cost effective and we allowed to persist a reimbursement system that put primary care medicine on the endangered species list.  We’re well beyond the point where relatively simple and painless solutions are viable options. 

If Dr. Sidorov is disturbed by “the mercenary tone of the [ACP’s] letter,” perhaps he should listen to that tone a little more closely.  I suspect he might hear the sound of chickens coming home to roost.

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