State of the Nation’s Health Care 2009
Primary Care: The Best Medicine for Better Health & Lower Costs
Robert B. Doherty
Senior Vice President
Governmental Affairs and Public Policy
American College of Physicians
I am Bob Doherty, ACP’s Senior Vice President of Governmental Affairs and Public Policy.
Dr. Harris has provided you a compelling explanation of why it is so important that patients have health insurance. And why it is equally important that they have a primary care doctor.
What can be done, what must be done, to ensure all Americans have health insurance coverage, and access to a primary care doctor?
Today, we are calling on Congress to help people keep their health insurance in these difficult times.
We are calling for comprehensive reforms that will lead to affordable coverage for all Americans. And we are calling on all agencies of government to enact reforms to grow the primary care workforce capacity at the same time as coverage is expanded.
This is what we recommend:
First, we have endorsed pending legislation to help people keep their coverage during these difficult economic times.
We support measures in the stimulus bill to extend and subsidize COBRA coverage for those who are at risk of losing it, to provide states with temporary funds to maintain current Medicaid enrollment, and to allow them to enroll low-income people who lose their jobs.
The State Children’s Health Insurance Program must be reauthorized and given sufficient funding to cover all eligible children.
These measures should be followed by enactment of a comprehensive plan to guarantee that all Americans will have affordable coverage.
Second, as coverage is expanded to more persons, there must be simultaneous, sufficient and sustained policies to grow the primary care workforce.
We call on President Obama and Congress to convene an expert advisory group to develop specific and measurable goals on the numbers and proportions of primary care clinicians needed and benchmarks to evaluate the impact of federal policies to attain those goals.
We call on the federal government and private payers to take immediate steps to make primary care compensation competitive with other specialties. Specifically, a market and price sensitivity analysis should be conducted to set specific benchmarks for improving primary care compensation so that it is competitive with other career and specialty choices.
For instance, Medicare payment increases of 7-8% per year over five years would be needed for primary care compensation to be at the 80th percentile of all other specialties. Right now, the average compensation of primary care doctors is 55% that of other specialists. Commercial payers would need to implement comparable increases.
We are asking Congress to expand the Patient-Centered Medical Home model to more states, more practices, and more patients. This innovative model of primary care delivery offers enormous potential to improve quality and lower the costs of care, especially for patients with chronic illnesses.
We call on the federal government to conduct a systematic review of paperwork burdens on primary care doctors that detract from the time they can spend with patients and add to physician dissatisfaction and burn-out.
We call on the federal government to increase funding for primary care training programs and create new programs to eliminate medical education debt for internists, family physicians, and pediatricians that agree to provide primary care in a critical shortage area or clinic.
In addition, we propose other reforms to improve the quality and efficiency of care for all patients, not just those seen by a primary care doctor. These include ending the annual cycle of Medicare payment cuts caused by the flawed Sustainable Growth Rate formula, improving the Physicians Quality Reporting Initiative, funding independent research on comparative effectiveness of different treatments, and helping physicians acquire the health information systems needed to deliver better care.
Finally, we are asking President Obama to consider issuing an Executive Order on Increasing Primary Care Workforce Capacity. This order would ensure that all federal agencies are working together seamlessly to design, implement, measure, and evaluate programs to increase primary care workforce capacity.
A Presidential executive order would send a powerful signal to young physicians and medical students – as they are about to make life-time career decisions – that the federal government is serious, really serious, about making primary care an attractive and competitive career choice.
It would send a powerful signal to primary care physicians in practice that they need to hang on, that better days are ahead.
There are several documents in your folders that explain ACP’s proposals in more detail.
One is a draft of a suggested executive order on primary care.
Another is our complete State of the Nation’s Health Care report.
Another discusses several options for funding primary care to take into account the evidence that costs will go down, and outcomes of care will be better, if we have more primary care physicians. We can provide you with additional information upon request on a wide range of funding options that we evaluated and the advantages and disadvantages of each.
Also included in your packet are several illustrations of how many more primary care doctors might be needed if President Obama’s health plan is enacted into law. We also have provided you with additional background information on the primary care crisis and the Patient-Centered Medical Home.
Let me end by emphasizing why coverage and primary care are inextricably linked.
We know from studies that patients who do not have health insurance coverage have poorer access, worse outcomes, and higher costs.
We also know from studies that patients who live in areas of the country with too few primary care doctors have poorer access, worse outcomes, and higher costs.
This tells us two things. Universal access to health insurance coverage is essential.
But universal coverage alone will not assure better outcomes and lower costs unless we dramatically increase the numbers of primary care physicians.
It is that simple.
Dr. Harris and I would be pleased to take your questions.
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