Thursday, October 5, 2017

Don’t Let Your Differences Restrict Your Access to Medical Care – Part I

Our differences are driving us to distraction. Pick a television network, any network, and expect to hear why we cannot agree on anything. Our political affiliations result in conflict. The timing of our immigration to America divides us. (Because with the exception of Native Americans, we are all immigrants.) Whether we shoot guns or don’t divides us. The options for differences are endless.

In reality, our similarities far outweigh our differences. Look down at your feet, consider your knees, work your way up and consider your whole host of internal organs. Consider your arms, and face, and top it all off with that brain in your head. Yep, we all have physical bodies that need maintenance and assistance. Our lungs get congested, our knees wear out, we need injections, and we break arms or toes.

Maybe you get your healthcare at a community health center. Maybe you have a family medicine physician who has treated you for your entire life. Maybe you periodically run to the urgent care center and don’t even affiliate with any physician.

Regardless of our differences, we all need primary care.

This Primary Care Week, instead of an endless debate about the Affordable Care Act (ACA) and its future, we need to ask ourselves the real questions.

·        How do we encourage young doctors to choose primary care?
·        How do we change compensation to allow the primary care physician (PCP) to earn a salary commiserate to their rich and varied practices and skill sets?
·        How do we reduce the debt physicians incur to enter a profession that limits their earning ability?
·        Where do advanced practitioners fit into the delivery chain?
·        How do we deliver healthcare to the most underserved?
·        How do we improve our support of the primary care provider and the organizations that deliver this care?
·        How do we increase the number of residency slots available for candidates?
·        How do we ensure that community health care centers can continue to serve their communities?

The Obama Administration did the ACA a huge disservice when they allowed the entire debate to revolve around the insurance mandate. The ACA was a comprehensive approach to the delivery of care to patients when and where they need it. Prior to ACA we had universal health care. It was called the emergency room. We can’t go back.

Do many Americans know that the ACA significantly changed the way that care is delivered to the underserved? No! Do they know that CMMS and National Institutes of Health are piloting new ways to compensate physicians? No! Do they know that the community health care system delivers care to the underserved in a far more efficient and effective manner than ever before? No! Do they know about the growth in urgent care and its place in the delivery channel? No! Do they realize that technology allows for care to be delivered in places previously unserved? No!

Tragically, the Centers for Medicare and Medicaid Services have already announced that they are cancelling three of the new reimbursement bundling programs intended to begin in 2018. Unfortunately, most of our opinions and knowledge are based on what political party we affiliate with and which agenda is driving the narrative. Political narrative appears to already be impacting good programs that would change the reimbursement models being tested.

This Primary Care Week, regardless of your political affiliation demand that your elected officials address the real issues. We don’t have enough providers and we don’t compensate them appropriately. We lack residency program slots to educate physicians. We restrict the flow of foreign medical graduates which further limit care to the underserved.

Primary care affects you. If you don’t think so, just wait until the next time you get the flu or your aging diabetic mom can’t get in to see a PCP because they don’t take Medicare. Or perhaps you will retire to a beautiful community in the mountains of Colorado only to find that no physicians are taking new patients with Medicare.

We can focus on our similarities and make a real difference, but not unless we stand up to be heard.

See Part II on the role of physicians in this issue. 

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