Medicare Wants to Save Primary Care … but is this the way?

Of all the problems in medical economics the plight of Primary Care physicians is certainly a valid issue.  In any preventive construct it will largely be Primary Care physicians who will form the skeleton of the system. And there is a problem …

In any business there is a natural tension between owners, who must survive on the net proceeds of the business and employees who can demand ever increasing compensation.  We are seeing this with Primary Care as overall physician income continues to drop while Advance Practice Nurses and Physician Assistants continue to demand higher and higher income.

What Medicare has done is ignore a basic economic model and instead punished specialists by refusing to pay for consultative services.  Keep in mind the services continue to be provided, an opinion is rendered and the patient is returned to the referring physician.

Placing one’s hands over one’s eyes does not a problem make go away.

And yet this is Medicare’s solution.  Keep in mind the basic problem does not go away and as we see so often the solution provided by Medicare is no solution at all but only serves to move the problem further into the future for some other administration and some other Congress to solve.

The approach to physician compensation is archaic and hearkens back to the days when solo physicians provided the majority of patient care.  Today’s health care system is designed to deploy a stratified approach to patient care based on matching specific training with the perception of need based on the patient’s specific condition.  At times this involves the use of Mid-Level Providers such as Advance Practice Nurses and/or Physician Assistants, often requiring supervision by a physician.  In such a situation not only does Medicare reimburse the encounter at a reduced rate, but provides no compensation for the physician for the assumption of risk and time commitment required to provide adequate supervision.

In the current reimbursement construct for Primary Care physicians who deploy Mid-Level Providers they find themselves in a downward spiral of compensation with more and more of their time spent supervising without compensation.  Make no mistake the solution is NOT to replace Primary Care with more Mid-Level Providers.  While talented and well trained Mid-Level Providers did not attend medical school while their supervising physicians did.

The solution does not involve ignoring the problem.  The solution involves paying the providers for what they do.  For physicians who deploy Mid-Level Providers, they deserve to be paid for their supervision.  For specialists who continue to provide consultative services?  Pay them for the work they do.

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