Re: Is inappropriate primary care the problem with US health care?

[Guest guest]

Completely agree. My posts the last couple of days were only intended

to spark a conversation about things we can do immediately to improve

our own performance while we advocate for proper support from the

system. I labeled the first post as " food for thought " - hope no one

thought my intent was to blame primary care for the mess. However, I

do believe that we will be most effective as a solution if we can show

that we practice in ways supported by evidence rather than habit or

patient demand. I know it's a chicken and egg problem - we don't have

a system that supports doing the right things so we often don't do the

right things. However, to be effective, I need to avoid the easy

route of simply blaming insurance companies, specialists, the

government and the stars for all that is wrong - we are not completely

powerless as primary care docs. That was my only intent in spurring

what I hope at least some found to be a friendly debate worth having.

Best and happy holidays.

Chad

>

> No need to speculate on this topic, there are volumes of publications on

> this issue. I present one of the most recent - not as the

> be-all-and-end-all of publications, but merely as a reflection of a

wealth

> of data.

>

>

>

> Parts of the US with greater concentrations of PCP per capita have

better

> satisfaction, better health outcomes, lower total cost.

>

> Parts of the US with greater concentrations of specialty care and

hospital

> beds have worse satisfaction, worse outcomes and higher total cost.

>

>

>

> The reasons are explained in the attached..

>

>

>

> Does this mean primary care is pristine and we only need more of us

around?

> Not for a second. There are certainly times when PCPs order

inappropriate

> tests and treatments, there good studies documenting the inadequate

levels

> of care delivered by PCPs in the US. This is an unfortunate

consequence of

> being put in the professional equivalent of Lucille Ball on the assembly

> line in the candy factory.

>

>

>

> The current system is perfectly designed to get us these woeful results:

> inadequate resources, low fee-for-service pay for visits and no

remuneration

> for all the other work of primary care, the unfunded mandate of the

insane

> administrative trivia game (billing, prior auth, and forms from here

to our

> collective grave). In general we are on a diabolical treadmill and

unable

> to live up to our professional obligations.

>

>

>

> We can work to put our houses in order, to use the best medical

information

> to support our patients, to provide superb access, excellent

continuity, a

> broad array of service, and coordinate care across the continuum

when we are

> adequately resourced to do the work and we lose the crushing yoke of

> administrative trivial pursuit.

>

>

>

> High performing health systems are founded on effective primary

care. Give

> us the resources and relief we need to do our work.

>

> G

>

[Guest guest]

Completely agree. My posts the last couple of days were only intended

to spark a conversation about things we can do immediately to improve

our own performance while we advocate for proper support from the

system. I labeled the first post as " food for thought " - hope no one

thought my intent was to blame primary care for the mess. However, I

do believe that we will be most effective as a solution if we can show

that we practice in ways supported by evidence rather than habit or

patient demand. I know it's a chicken and egg problem - we don't have

a system that supports doing the right things so we often don't do the

right things. However, to be effective, I need to avoid the easy

route of simply blaming insurance companies, specialists, the

government and the stars for all that is wrong - we are not completely

powerless as primary care docs. That was my only intent in spurring

what I hope at least some found to be a friendly debate worth having.

Best and happy holidays.

Chad

>

> No need to speculate on this topic, there are volumes of publications on

> this issue. I present one of the most recent - not as the

> be-all-and-end-all of publications, but merely as a reflection of a

wealth

> of data.

>

>

>

> Parts of the US with greater concentrations of PCP per capita have

better

> satisfaction, better health outcomes, lower total cost.

>

> Parts of the US with greater concentrations of specialty care and

hospital

> beds have worse satisfaction, worse outcomes and higher total cost.

>

>

>

> The reasons are explained in the attached..

>

>

>

> Does this mean primary care is pristine and we only need more of us

around?

> Not for a second. There are certainly times when PCPs order

inappropriate

> tests and treatments, there good studies documenting the inadequate

levels

> of care delivered by PCPs in the US. This is an unfortunate

consequence of

> being put in the professional equivalent of Lucille Ball on the assembly

> line in the candy factory.

>

>

>

> The current system is perfectly designed to get us these woeful results:

> inadequate resources, low fee-for-service pay for visits and no

remuneration

> for all the other work of primary care, the unfunded mandate of the

insane

> administrative trivia game (billing, prior auth, and forms from here

to our

> collective grave). In general we are on a diabolical treadmill and

unable

> to live up to our professional obligations.

>

>

>

> We can work to put our houses in order, to use the best medical

information

> to support our patients, to provide superb access, excellent

continuity, a

> broad array of service, and coordinate care across the continuum

when we are

> adequately resourced to do the work and we lose the crushing yoke of

> administrative trivial pursuit.

>

>

>

> High performing health systems are founded on effective primary

care. Give

> us the resources and relief we need to do our work.

>

> G

>