This post is the 2nd in a series discussing our findings in a recently published study on the ways family physicians deliver better care at a lower cost than a multi-ologist model.
Family physicians reported that they typically triage large amounts of information in a clinic visit and are able to prioritize and triage that information to take appropriate actions. Examples included patients with symptoms all over their bodies, each with differing time courses. Family physicians would not send every patient who uttered the phrase “chest pain” to the ER, not order an MRI for every patient who reports a headache, nor would they order the rheumatology 2000 panel for every patient who reported joint pains.
To compare their decision making to other physicians, ER doctors were commonly mentioned as the counter point: for example, ordering imaging for patients who have had headaches for 20 years and 6 normal CTs in the last 10 years. The family physicians’ knowledge of their patients’ complicated histories, including previous testing results and their memories of specific descriptions of the relevant symptoms, contributed greatly to their efficiency.
In a separate project, my participation in the CMS Innovation Advisors Program, I witnessed firsthand the volume of information family physicians must triage and prioritize. I shadowed 15 family physicians, most in private practice, and watched them take care of over 140 patients in their clinics. The AVERAGE number of separate issues they addressed was 4 per visit. In two visits I observed, the physicians dealt with 11 different issues. Think of the efficiency of this phenomenon. The patient could see one family physician for 11 different problems, or the patient could make 11 separate trips to ologist offices, each one ordering its own labs, its own imaging, and its own prescriptions.
But CMS and the insurance companies stop paying family physicians for their work after they address two issues. This reality is buried in the complexities of the CMS Evaluation and Management documentation, coding, and billing rules. This chronic rip-off of the family physicians’ valuable work, in my opinion, is the single greatest contributor to family medicines chronic sickly state, and the area in most need of payment reform.
But will family physicians ever grow a spine and demand to be paid for the valuable work they do? I haven’t seen it demonstrated so far in the AAFP or other FM organizations. The way the AAFP crawled back to the RUC after most of their demands were ignored. It was pathetic.
No one is going to just give family physicians fair payment for their work if they continue to give it away for free. Only they can demand reform. It just takes more courage than they’ve ever shown.