As the nation careens toward individual mandates to purchase health insurance many are wondering how this will do anything to reduce health care costs in the US. Massachusetts is a few years into the same experiment and noticing that the results are not as good as one would hope if you're hoping that the experiment results in reduced health care costs.
The good news is that there are things practices can do that improve care, delight patients, make the office a better place to work and reduce unnecessary costs. As I've written before, primary care practices that eliminate waits and delays and improve the timeliness of communication help people avoid going to the emergency department for care that could have been delivered in their primary care doctor's office.
This is no small help - a major insurer in Massachusetts told me last week that 60%+ of emergency visits are unnecessary. A visit to the ED costs 10 to 20 times more than a visit to the PCP. For a patient with a bad headache, the ED might perform a raft of unnecessary tests & drive the costs to 100x of an office visit, to say nothing of the massive inconvenience to patients & family of an ED visit.
The biggest impediment to practices trying to pull this off is that each doctor has more patients than they can manage - their 'panel size' is often 2000-3000 patients per doctor. Some argue that the doctors should take even more. The problem is that these boated panels cost patients not just intolerable waits and delays but patients suffer worse outcomes.
From studies by John Wasson et al (ref below) we see that patients served with waits and delays have less control over their chronic conditions, are less likely to have preventive care needs met, are more likely to miss days of work & school and are more likely to end up in the ED or even be hospitalized.
The right panel size is that which the practice can manage without creating waits & delays. Taking on too many patients results in unintended harm to those patients and should be stopped. Failure to address this at the policy level is a clear example of pushing practices to hurt their patients.
Improve access and relationship for ALL patients in the practice, not just the lucky few with a particular condition. This is one of the pillars of effective primary care.
Wasson, J. H., Johnson, D. J., Benjamin, R., Phillips, J., & MacKenzie, T. A. Patients report positive impacts of collaborative care. Journal of Ambulatory Care Management, July-September 2006 29(3), 199–206.