Our country lags far behind others on health care
quality in spite of spending more than twice as much per person as other
countries. Decades of research identifies our lack of investment in primary
care as the essential flaw. This flaw results in missed opportunities for
preventive care and early intervention, leading to high incidence of avoidable
illness and complications of chronic disease that drives up health care
costs.
Effective primary care improves quality, improves the experiences
people have with care, and makes health care more affordable for all. The
pillars of effective primary care are in place when patents say:
- "I can get care when
I need it"
- "I have one
doctor/health care provider who knows me"
- "My primary provider
takes care of most of my needs"
- "My primary provider
coordinates my care"
The work of effective primary care is punished by our
current fee-for-service environment, which rewards volume of services rather
than quality. We are paid for "volume of office visits," while much of the
essential work of primary care is considered valueless. Effective primary care
is much more than what happens in an office visit. It also includes:
- Reassuring a new mom
at 11PM
- Helping an elderly
woman deal with the grief over loss of her husband
- Getting the full
story behind a biopsy result to be able to explain it to a frightened
family
- Taking the time to
listen as a person comes to grips with their alcohol
abuse
- Searching for
answers in the medical literature
- Spending time
coordinating care for patients receiving care from several
doctors
Attempts to improve quality and reduce costs through
current regulation and policy have created an untenable burden of administrative
trivia. This crushing burden drives up costs by forcing us to hire clerks to
respond to endless "mother-may-I" authorizations. Our attention is diverted
away from actual care for our patients to address countless inquiries about the
care we deliver.
The primary care workforce is stressed to the breaking
point. It has become a repugnant and illogical career choice. Finishing
medical school deep in debt, a student is unlikely to take a pay cut of
$100-$200,000 per year for primary care versus specialty practice. It is no
wonder medical students avoid the long hours, low relative pay, lack of
autonomy, and impossible frustrations of primary care.
We know how to do
this work. We want to do this work. We need real reform so that we can do this
work.
Real reform will provide primary care with the resources to do all
that we were trained to do. For less than 10% of our nation's health care tab
we can provide excellent primary care for all Americans. This will afford us
the tools and time we need to improve communication with our patients and to
coordinate care across the current health care silos. We will:
- provide access for
all
- engage in reliable
prevention
- deliver superb
chronic disease management
- work for our
individual patients as well as the populations we serve
- coordinate care
across the health care continuum
Real reform will lift the administrative burden that
yokes us to legions of clerks who mire us in trivia while restraining us from
real care.
Real reform will not take the form of Health Information
Technology vendor hyperbole but will enable us to use technology that actually
works in the front lines of care.
Real reform improves health care access
for all Americans by enabling effective primary care for all and not merely
providing another windfall for the insurance industry through "insurance for
all."
We in the front lines of care are ready and willing, and hope you
can hear our desire to be among the solutions our country so desperately needs.
Please look beyond the usual cast of characters and include us. We can help you
craft policies that promise to make us not only ready and willing but ABLE to
deliver on the full scope of our profession and your desire for real health care
reform.
Respectfully,
L. Gordon
Moore MD
Ideal Medical Practices Project - a volunteer community of front
line providers collaborating on delivering superb care in spite of a toxic
environment
Seattle
WA
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