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    Thursday, December 15, 2005

    Time for Change: Here's an interesting proposal - separate Medicare payments into two separately funded groups - primary care physicians and specialists. The argument is that primary care takes budget cut hits in response to increased specialty care spending:

    The services of primary care doctors have long been undervalued by the Medicare programme, which often cuts its annual payments to cope with overspending on procedures in secondary and tertiary care.

    ....Separating funding for primary care from secondary and tertiary care could protect primary care from costs in more expensive settings and preserve access to primary care for patients. The UK has tried various means of separation, and the US could learn from these. One mechanism for this in the US would be to split the Medicare sustainable growth rate formula into evaluation and management codes (which mainly apply to primary care) and other codes (mostly procedural and used in secondary and tertiary care). This would protect the most important primary care functions from the cost cutting required when Medicare spending targets are exceeded (largely due to procedural costs).

    Separation of funding for primary and secondary care could also facilitate different ways of paying for care and the transformation of primary care. Other healthcare purchasers and payers could make similar separations in their funding pools since they tend to follow Medicare's lead in payment policies. Such a separation could also promote quality and safety by assuring access to essential and robust primary care services while reducing overuse of other treatments.


    He also suggests that all primary care physicians - internists, pediatricians and family physicians - should join together to improve our political clout.

    These aren't bad ideas. It's true that primary care takes the hardest hits when Congress decides its time to cut back on the budget, even though we aren't responsible for the burgeoning cost of Medicare. It's also true that as the population ages, it's the specialty and hospital care that they're going to be needing more and more. Will Congress listen? I doubt it. Most politicians are like every one else - they have trouble understanding the concept of primary care - or of believing that a primary care physician is capable of providing most of a person's medical care. But, maybe, if we join forces, we can get them to listen.
     

    posted by Sydney on 12/15/2005 08:25:00 AM 3 comments

    3 Comments:

    There needs to be a disincentive to use specialty care. Many Medicare beneficiaries that are well off (enough to afford medigap insurance) have no out of pocket fees to see specialists. They can self-refer and they don't hesitate to go to several different docs for each organ system - and then be followed chronically for what may have been an acute problem. I was a PCP at the VA and had many such patients coming in for meds. It was amazing how many docs they saw and how little one seemed to communicate with the other.
    I am now in cardiology at the VA. We routinely get consults from PCPs for patients who have outside private cardiologists, but the pts want to see a VA cardiologist too.
    "Just because", or for a "second opinion" - not that they will heed that second opinion mind you.
    They have no insight into the fact that they are using up scare healthcare dollars by "double dipping". If the vet does not have a service connnected cardiac condition and is seeing a private cardiologist, many times our attending will deny the consult as we have finite staff and cannot accommodate every patient who wants to be followed in cardiology.

    CardioNP

    By Anonymous Anonymous, at 10:50 PM  

    Just what we need, more reasons to pit doctor against doctor.
    The problem is, the "system" if you want to consider it that, does not reward the conscientious or the frugal. Money which is saved goes elsewhere, and for private insurance this means to shareholders and for ever-increasing bonuses for executives, "for doing such a good job."

    For the public sector, money saved merely leads to the next round of budgetary cuts.

    And the VA -- its own world. My patients go to the VA so they can get medications, and the VA says you have to see a VA doctor to get those medications, whether you want (or need) the VA doctor or not.

    By Blogger Greg P, at 9:29 AM  

    i agree with you. here are my reasons:
    http://www.njafp.org/njafp_custom/resources.asp?CategoryID=51

    By Blogger Dr. Charles, at 6:15 PM  

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