If on average each
primary care provider had 1500 patients (adjust as needed for part time,
case-mix, etc)
And each patient came
with a payment (a voucher maybe?) for $350/year (adjust for case-mix
etc)
Then the practice would
receive $525,000 per year.
With 305,000,000
Americans by last count, this would be $107 billion per year for primary
care.
This is less than 5% of
the $2.1 trillion the
It is incomprehensible
to me that we systematically withhold adequate resources from primary
care.
A dollar a day per
person.
I could do so much more
for my patients if I had resources adequate to the
work at hand.
A pilot group in the
IMP project has been working on helping patients get the most out of specialty
consultations [Core attribute of primary care – coordination of care across
the continuum].
- Janice
Pegels coaches her patients with complex
issues to create a “no more than two page” summary to capture the essence of the
complex history to save the specialist having to weed through an inch of chart
while simultaneously eliciting the patient’s agenda (evidence shows that
eliciting patient agenda improves visit efficiency as well as the probability of
meeting patients’ needs)
- Because he continually updates the
problem and med lists Larry
Lindeman is able to very quickly type out the reason for consult and
print it all out to hand to his patients before they leave the office so that
they never show up at a consult where a specialist has nothing to go on (Larry
finds that many specialist offices lose incoming faxes of new
patients)
- Jean
Antonucci uses a tickler system and then
contacts her patients the day after the scheduled consult to find out how it
went, catch up on any details and manage the coordination of
care
- Judy
Zettek spends time negotiating health
behavior change plans during office visits and then follows up within a week and
then ongoing to help patients problem solve around the issues of daily
life.
Each could spend time
playing Billing Twister to figure out how to squeeze a dollar from the insurance
stone, but by and large this essential work of primary care is without value in
the current paradigm. It is time for an entirely new
paradigm.
The www.PatientsAtCenter.org proposal
sets the stage for a conversation about a new paradigm. As you see from the
numbers above the total price tag is affordable.
Based on decades of
research, unlocking the potential of primary care through adequate resources
should be the foundation upon which a high performing health system is built and
the cornerstone of any serious effort of healthcare
reform.
Gordon
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