The Primary Care Scare

October 9, 2014

Crisis, real or manufactured, feeds politics and the press. In the real world, we have real problems and need real solutions. One is the primary care scare.

"The Primary Care Scare" is the first of a series - Fixing Healthcare - where we take the press, pundits, and politicos' to task and provide the mindful practicality, common-sense solutions, and efficient options with which they could have balanced their stories.

First up: Smart enough to see a problem, no clue how to fix it, or, the sky is falling and you can stand under my umbrella for just whatever you have in your wallet (MasterCard and Visa accepted), but first, a word from…:

"Medical Experts Say Physician Shortage Goes Beyond Primary Care," Association of American Medical Colleges Reporter: February 2014

"Are There Enough Doctors For The Newly Insured?," Kaiser Health News, Jan 3, 2014. "Americans who have enrolled in health insurance for the first time under the [Affordable Care Act] are likely to discover that having coverage doesn't guarantee them easy access to a primary care doctor, dentist or mental health professional."

"Supply won't meet growing demand for primary care,"USA TODAY, June 30, 2014

And those are just the top three of nearly 800,000 results in a specific Google search about the anticipated primary-care physicians' shortage.

To be fair, there really will be a shortage, particularly in rural areas, if policymakers, power brokers, and legislators don't listen to people who will actually have to solve the problem and live with it, or as we common folk say, people with the common sense and integrity to identify simple, practical solutions instead of expensive, complicated schemes.

Not that those I am so inelegantly skewering don't have good intentions – they do with rare exceptions – they just keep repeating the same mistakes, like hiring academics, engineers, and policy wonks to fix a plumbing problem instead of a plumber.

UnitedHealth, for example, just published a report that identifies four "Practical, Proven, and Scalable Approaches" to manage the prospective primary-care physician shortage:

• Medical homes;
• Accountable care organizations;
• Value payments; and
• Information technology to manage the process.

Medical homes were never intended to be a permanent solution, just the first step to one. Accountable care organizations are failing because they are doing the same things and expecting different results. Most physicians fear value-based reimbursement because they fear having to be accountable for, and paid commensurate to, results without the tools, training, and transformation it will take to succeed and, by the way with bureaucrats making the rules, EHR technology is not a solution, it is a data warehouse. A solution takes actionable information that comes from data.

There are at least a dozen physician-managed organizations that have figured this all out, have the solutions, and are implementing them. They are not only expanding capacity, but doing it safely with vastly improved quality, outcomes and at a fraction of the cost. In the short term, the "crisis" will be more of a temporary inconvenience and in the long term, if they are allowed to do their jobs, an oversupply that can be tasked to a permanent solution.

That is, if they are allowed to. They gore an awful lot of establishment oxen and turn power bases on their heads. That's always been a dangerous combination for disaster.

You can call me cynical, but, the reality is, I'm just the proverbial plumber.