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Shall We Overcome? – Reversing Decades of Primary Care Payment Bigotry

June 4, 2014
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OK, I’m back. (I had several weeks of intense work and family obligations). And OK, I’m going to go for it with the payment reform stuff.

I will spend the next several weeks trying to explain to a general audience why the payment system for physicians is extremely rigged in favor of the doctors who only worry about one body part, and why patients should care about this issue.

I’ve listened over the years to well-meaning people say that the general public doesn’t care about physician payments, because they think all doctors are rich and any physician who complains is just whining. This is a huge mistake on the part of people who want to have a long-term relationship with comprehensive family physicians as their primary care givers, and those who want better healthcare at a lower cost.

Let’s take a somewhat corny example to help illustrate the point. Imagine there were federal regulations that limited a hair stylist to one low fee, no matter how fancy the desired cut, washing, blow drying, coloring, perming, frosting, or any other desired services by the customer. First, stylists would start forcing customers to make many trips to receive each individual service allowed under the one fee. Customers would tire of this and a chronic tension would grow between the regulated service provider and the customer. Customers would always try to stretch out the visit, “Couldn’t you just add a touch of color here? or “Could you blow dry my hair real quick?”

As stylists grow older and more weary of the chronic discomfort of the mismatch between customer expectations and what the stylists are allowed to be paid for, they would retire or change jobs, and few new stylists would want to be trained to take their place.

And what if a stylist was bold enough to charge a customer for a compete and fair list of services provided in one sitting? If Medicare was the payer, the stylist would be liable for penalties, fines, and jail time resulting from the accusation that she committed Medicare fraud. The penalties and fines would not just cover the discovered “abuse.” It would retroactively apply to the previous five years of Medicare claim submissions, based on a review of TEN cases.

So now when American women (and a few men) can’t find a stylist anywhere to care for their hair, might they start to care about the role Medicare and other insurance company payers that caused the shortage? I would certainly hope so. So far it hasn’t seemed to happen much as patients try in vain to find a family physician taking new patients sooner than three months out, as they drive by an endless sea of urgent care centers and free-standing emergency rooms.

The series of posts will be based on research I and colleagues from around Texas recently published on family physicians’ opinions about the current payment system. It’s a qualitative study, so the actual journal article should be an easy read with good stories to back up the main points, even for non-physicians.

One final point: I realize bigotry is a strong word, but it is absolutely accurate. In classic thinking of bigotry situations, the issue is unfair pay or working conditions for similar work. In the case of family medicine, it’s even worse than this. Family physicians deliver better care at a lower cost, but make less than all other physicians. It’s not less pay for the same work; it’s less pay for better work. And Medicare (CMS), the insurance companies, and the American Medical Association are squarely to blame.

And patients and payers should begin to really care about this, unless they want to continue to pay exorbitant costs for crappy, inconvenient, impersonal healthcare.

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One Response to Shall We Overcome? – Reversing Decades of Primary Care Payment Bigotry

  1. R Watkins on June 6, 2014 at 12:58 pm

    “And Medicare (CMS), the insurance companies, and the American Medical Association are squarely to blame.”

    I would also include the AAFP because of their ongoing and incomprehensible refusal to confront what has been obvious for the past 20 years.

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