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More Ignorance on the Cost-Effectiveness of Family Medicine

June 18, 2012

A normally very respectable and reliable source of healthcare observations, the Center for Studying Health System Change (CSHSC), had a bad day recently. A report by one of its fellows for the Commonwealth Fund modeled “real-world” parameters found that if primary care physicians were paid more, Medicare could save 2%.

Two percent?!!  Are they kidding?

This estimate flies in the face of more telling real world examples of well-supported family medicine delivering 20-30% deceases in overall healthcare costs. Examples include observations by Baicker and Chandra, recent experience in some of the PCMH demonstration projects, and the results of new primary care models delivered by QuadMed and WeCare (though the overall cost decrease percentages in the PCMH approaches are less than other models. I think it’s because of the cost of some of the PCMH baggage that these clinics carry in addition to the family physicians).

Family medicine is already misunderstood my much of the American people and its leaders. It’s a shame when institutions such as the CSHSC and the Commonwealth Fund blow a chance to rectify this.

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3 Responses to More Ignorance on the Cost-Effectiveness of Family Medicine

  1. Robert Watkins on June 19, 2012 at 10:31 am

    I’m inclined not to be so harsh on the authors.

    What they’ve neatly shown is that you can’t toss a crumb to primary care docs and expect them to change their behaviour. The “10%” increase in payment is actually 10% of the 80% of allowables that Medicare pays, and applies only to E&M codes. For most practices, the cash paid out was so negligble as to not even register as a blip on the bottom line. The increase needs to be at least 40-50% if we want to encourage primary care docs to provide really comprehensive services. What this does show definitively is that CMS still holds primary care in absolute contempt.

    I’ve been completely unimpressed with the “data” coming out of PCMH demonstration projects (usually self-reported by large insurers). What is clear is that the big payors see the PCMH as a way to jack up profits, a fact that the AAFP is choosing to ignore.

    • Richard Young MD on June 19, 2012 at 9:59 pm


      Besides their primary conclusion, I had two problems with the author’s approach: 1) they analyzed claims data from the early 2000s, yet felt they could take data from the anti-primary care payment system and draw conclusions about results in a different system, and 2) there was no mention in their discussion about how their results conflicted with previous research.

      Nothing about their analysis included data from primary care docs who actually received increased pay.

  2. Chris Gregory on June 19, 2012 at 12:34 pm

    I really wish we could get past this perception that PCPs are whining about getting paid more. That’s not the point. If I were king, I’d re-engineer the world so that primary care docs could spend the necessary time to be the comprehensive care givers that they don’t have the luxury to be now. Then I’d just pay them fairly for the stuff they do. A lot would get worked out if we just did that, but the power structure(s) are just to damned dumb to get the picture.

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