Are office visits undervalued as compared with procedures?

The Virtual Patient thinks so:Office Visit

Our health care system is built upside down today and that is the reason for excessive costs. Insurance companies are willing to pay for expensive procedures at the same time they are reducing the amount paid for office visits to doctors.

I am convinced that paying doctors twice as much as is currently allowed for office consultation and evaluation would drastically reduce medical costs…

This echoes the words of Dr. Jennifer Frank writing in Family Practice Management back in 2007:

As a family physician, I have the opportunity to save the lives of my patients every day. For example, helping patients with diabetes to lower their A1Cs, take their medication, stop smoking, start exercising, control their blood pressure or a host of other primary, secondary and tertiary prevention measures keeps patients from ever getting to the ICU in Mary’s condition. Yet this type of “life saving” is not appreciated and glorified in the same way as critical care. It is much more exciting to see a critically ill patient saved from the brink of death than to see a primary care physician initiate aspirin chemoprophylaxis. The U.S. medical community is just as enamored with highly specialized, resource-intensive medicine as is the audience of “ER.”

While it is a strength of our health care system that we can perform interventions that save critically ill patients, it is a failure of our system that the majority of our training and spending is focused on high-tech interventions for a few patients rather than preventive care that would aid thousands more. For example, screening for and preventing the complications of hyperlipidemia is often not reimbursable, but the cardiac catheterization five years later to evaluate and treat coronary artery disease is highly reimbursable. It seems our system is set up to reward failure – the failure to prevent disease.

As I noted before, preventive medicine is often not very cost effective.  But The Virtual Patient and Dr. Frank’s points are well taken.  You get what you pay for and what we pay for in American medicine is high tech procedures not low tech — and low cost — cognitive skills.  But I don’t think this will last indefinitely.  The increasing requirement for prior authorization for and not infrequent rejection of expensive imaging studies like MRIs and the common refusal by insurance companies and pharmacy benefit management companies to pay for non-generic drugs is a sort of tacit admission that our health care system is too enamored with high tech, high cost solutions to problems for which cheaper alternatives exist.

With no disrespect to the procedural subspecialties and the good work they do, the health care pendulum will eventually swing back — and is perhaps already starting to swing back — to primary care.

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