President's Message

We Must Resuscitate Primary Care

Physicians in Massachusetts have operated under financial and work-environment stress for many years. Nowhere is the workforce more squeezed -- and practice viability more threatened -- than in the primary-care arena. The number of medical school graduates choosing primary care is plummeting, and many in the field are leaving it or retiring. Waiting times for new appointments with PCPs in Massachusetts are among the longest for any specialty.

The American College of Physicians (ACP), the nation’s largest specialty society, recently issued a report on the impending collapse of primary care. The report calls for four major reforms that would help ensure enough highly trained PCPs to meet the rapidly growing health care demands of an aging population. The following four proposals from the ACP dovetail nicely with many MMS principles and our advocacy agenda.

The first proposal cites the need for so-called “advanced medical homes” -- practices that provide comprehensive, coordinated, evidence-based care to ensure high levels of quality, accessibility, and efficiency. One hallmark of the advanced medical home is health information technology (see related article).

Development of such practices would depend partly on new reimbursement models. Consequently, the ACP’s second proposal calls for fundamental reform in how payers determine “value” of physician services. Primary care physicians spend much time and energy providing evaluation and management (E&M) services and coordination of care activities that are chronically undervalued and poorly reimbursed. The ACP proposes that payers begin to pay for the extensive “non-encounter” activities essential to continuity and coordination of care, including telephone discussions and e-mail contact. Payment for primary care should reflect the full extent of the effort it entails and the value it creates.

The third proposal addresses financial incentives. Any Medicare pay-for-performance program, says the ACP, should:

• Be nonpunitive
• Prioritize the “top 20” conditions as identified by the Institute of Medicine
• Be sufficient to offset physician investment in IT and other innovations
• Not be grafted onto already flawed payment methodologies.

The fourth and final proposal calls upon Congress to scrap the sustainable growth formula method of calculating reimbursements. It has put many physicians out of business while failing to curtail the volume of inappropriate services.

Our adult and pediatric patients desperately need access to effective, high quality primary care. We cannot let this part of our system implode, lest the state of the entire health care system deteriorate further into higher costs, lower quality, and reduced access.

– Alan M. Harvey, M.D., M.B.A.