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Primary Care Boost Seen as Key to Overhauling U.S. System

By John Reichard, CQ HealthBeat Editor

January 23, 2007 -- The nation could save money and improve the quality of care by overhauling the way it pays primary care physicians, the professional association representing those doctors said Monday. A payment overhaul would boost preventive care in the U.S. and reduce the number of costly hospitalizations, said officials with the American College of Physicians (ACP), which represents 120,000 internists and medical students.

A premise of the overhaul is that the current U.S. system puts one doctor in charge of the overall care of a patient in relatively few cases, leading to treatment that is excessive in some respects and deficient in others.

Under the revisions proposed by ACP, "physicians would be paid for taking responsibility for coordinating the care of the whole patient," Robert B. Doherty, senior vice president for government affairs, told a Washington, D.C., press briefing Monday.

To qualify for the payments, physician practices would have to show an accrediting organization—ACP isn't saying yet which one—that they have systems in place to deliver what the association is calling "patient-centered care."

ACP caught flak from the press at the briefing for pitching the proposal using that and other jargony terms to explain how it would transform health care. Patient-centered care "provides continuous access to a personal primary or principal care physician who accepts responsibility for treating and managing care for the whole patient through an advanced medical home," an ACP statement explained.

In addition to accepting responsibility for the overall care of a patient by leading a medical "team," an "advanced medical home" increases efforts to improve safety and quality, ACP said.

Doherty boiled it down by saying that improved primary care can prevent unnecessary admissions to intensive care units (ICUs) and other forms of costly care.

And ACP said it will emphasize to Congress that there is nothing theoretical about the advantages of patient-centered care. Other countries have adopted the model and achieved better quality and more efficient use of resources, Doherty said. "States that rely more on primary care physicians consistently have lower Medicare expenditures, lower utilization, and fewer ICU deaths, fewer hospital admissions, and better composite overall quality scores," he said.

The payment changes proposed by ACP would address what its president, Lynne M. Kirk, described as the "collapse of primary care medicine in America." With higher incomes available in other types of medicine, fewer debt-laden medical students are going into primary care even as the need for coordinated care among the aging U.S. population increases.

"If our recommendations are accepted, Medicare would no longer pay physicians based solely on how many procedures or visits are billed," Doherty said. Practices accredited as offering patient-centered care would get payments ahead of time for delivering a defined package of services to a patient.

Doctors would have to show that they have systems in place to do things such as generate reminders to patients to practice certain forms of preventive care, track the care delivered to patients with chronic diseases such as diabetes, and give patients greater access to doctors through e-mail and phone calls.

Doherty suggested that savings from wider adoption of the model could help pay for the overhaul of the current Medicare physician payment formula, which is triggering a series of yearly payment cuts that can only be blocked through legislative action.

Although it said the approach would save money, ACP acknowledged that savings might take time to materialize. And spending on primary care should be increased, it advised. The new payment structure should result "in a substantial increase in payments to primary" care doctors, ACP said.

Among the legislative changes ACP is seeking is an expansion to the entire nation of the current pilot project in Medicare that pays doctors more in eight states if they provide a "medical home." The association also released other policy recommendations Monday calling for expanded coverage of the uninsured through expanding federal health insurance programs and allowing low-income Americans to buy into the Federal Employees Health Benefits Program.

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