By W. Mike McCrady, M.D., and Anne McCrady
While politicians debate health care reform in Washington, here in Texas change is already affecting the practice of family medicine. In hospital board rooms and medical staff meetings, local doctors are hearing about the transformation of primary care, payments based on quality and value, and the expectation of providers to capture a larger and larger market share. There is a confounding list of issues behind these pressures: some legislative, some economic, and others technological. In response, around the state, not just doctors, but administrators, legislators, and consultants are weighing in on the critical role of primary care to manage cost, ensure continuity, and meet patients’ needs.
With so much at stake, Texas family physicians face a daunting future. How should we respond to these changes? As with so many things, the answer seems to be to work together. For a rapidly growing proportion of us, that means joining forces with other providers, often as part of a hospital system. A report from the Texas Department of State Health Services shows a drop in the percentage of physicians who identified themselves as being in partnerships from 50 percent to 30.2 percent in the past 10 years. This decreasing number of small medical groups is also documented in national statistics. In fact, a recent New England Journal of Medicine article predicts that by 2012, 40 percent of active primary care physicians will be employed by hospital systems.more
By Melissa Gerdes, M.D.
TAFP President, 2010-2011
Adequate payment for primary care health services has long been an issue for family medicine. The absence of adequate payment has affected our specialty in numerous ways, including forcing physicians to see too many patients too fast, causing student interest in family medicine to decline, and leading practicing physicians into non-clinical careers. This migration of physicians away from family medicine has a negative effect on the public and our patients. According to the Commonwealth Fund, countries that have a lower proportion of primary care physicians to patients have populations with higher morbidities and poorer health outcomes.
Our current payment system is volume-driven, where physicians are paid more for doing things to patients than for doing things for patients. Research shows that doing more things to a patient does not automatically result in improved health outcomes. In fact, such practice very often results in worsened health outcomes. How do we migrate away from the volume basis?more
Last Friday, the medical community was shocked and saddened by the sudden death of pediatrician and primary care advocate Barbara Starfield, M.D., M.P.H. During her decades spent at Johns Hopkins, she authored and co-authored numerous studies on the value of primary care that provided proof that many of us believed in our hearts but couldn’t quantify—that patients are healthier and costs are lower in a system based on primary care.
However, her work provided more than just facts; it provided the footing for a movement to redesign the fragmented system to one that is better for patients. She inspired us to really take a look at family medicine’s contribution and advocate for its importance. The process has been slow, but her momentum kept it going.
Because of her tremendous contributions to health care research and patient care, several organizations have released poignant and appropriate statements in tribute that must be shared. The first is the full statement from Roland Goertz, M.D., M.B.A., president of AAFP, and the second is an excerpt from Richard Roberts, M.D., J.D., president of the World Organization of Family Doctors.more
An important piece of legislation designed to improve quality and lower costs in our fractured and inefficient health care system has received a second chance in the Special Session after dying in the House when time ran out on the 82nd Texas Legislature. However, because of other actions taken by our legislators that defund primary care residency training and other programs to bolster the physician workforce now and in the future, Senate Bill 8’s laudable goals are left without the means to achieve them.
The overarching goal of S.B. 8 is to reverse the negative trend in our health care system, to bend the cost curve by testing and implementing various performance-based payment methods that provide incentives for improved patient outcomes. It achieves this through two key mechanisms: the creation of health care collaboratives and the creation of the Texas Institute of Health Care Quality and Efficiency.
As envisioned in the bill, health care collaboratives clinically integrate physicians, hospitals, diagnostic labs, imaging centers, and other health care providers, aligning financial incentives to keep patients healthy and out of the hospital and emergency room. They are designed to move the delivery system away from a fee-for-service based system—where physicians and hospitals are paid for quantity of services over quality—to one in which doctors, hospitals, and other providers are accountable for the overall care of the patient and the total cost of the care provided.more