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All Things HIT

Mar 16 2012   9:20AM GMT

PCPs are primary for access and lower costs

Posted by: AllinHIT
Affordable Care Act, Medicaid, Medicare, PCPs
I recently read an article in The Hospitalist about Massachusetts’ Healthcare Law going into its sixth year in existence. The article states that Massachusetts is a microcosm of what we should expect with the Affordable Care Act. The author states that access and cost challenges still exists in Massachusetts, and the ONLY solution is with fundamental payment reform. I agree that payment reform is PART of the solution (fee for service vs bundled payments/quality measures); however, it’s not the only solution.

There are other solutions that collectively can aid Massachusetts, other states and the federal government in addressing access to care issues and lowering healthcare costs. One solution, for example, is giving Medicaid patients better access to primary care physicians (PCPs) as a preventive measurement. A PCP’s role is central in lowering costs, especially when it comes to providing post-acute care, by eliminating unnecessary hospitalizations, which brings up another question: how do we increase the number of PCPs? This is an especially difficult question to answer in a time when PCP’s are dwindling due to reimbursement cuts, Medicare’s low sustainable growth rate (SGR), state delays in raising Medicaid fee schedules, and even the transition to EHRs, are getting some PCPs to retire?

Speaking of retired PCPs, one of my proposed solutions for increasing access and lowering costs is to develop a post care “volunteer” program involving retired PCPs playing a central role. This group can conduct “house calls” or utilize telehealth tools in order to provide follow-up care, especially in post discharge/post-acute care for Medicaid and Medicare patients.

We can also include retired specialists, where they could provide post care for their specific condition specialty with the retired PCP coordinating the effort. I know, it sounds like a Medicaid ACO. I do believe that as an incentive though, these “volunteers” should receive an honorarium from payors and other stakeholders and should be free of taxes if they are of retirement age.

Another idea for increasing access to PCPs, and hence lowering costs, is to take a Teach for America approach with medical students. Like Teach for America, the “PCP for America” program can subsidize the student’s medical school costs and delay student loan payments, all for “volunteering” to provide post-acute visits under a supervising physician’s guidance. I can continue to refine and define these programs, however, I think you get my point. We must think “out of the box” to address the systemic issues with access and costs, especially since 200 million people are coming into the healthcare delivery system with the Affordable Care Act.

Lastly, there are lots of solutions and not just one magic bullet. It will require a “shotgun” approach, spraying pellets everywhere and seeing what hits the target!

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