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The Power of Comprehensive Family Medicine

June 7, 2015

Hello again!¬† I haven’t written anything in a while. No big worries. I moved recently (same town, same neighborhood), but the remodel of the new house has been a mis-adventure and I’ve been living out of boxes and breathing dust for over a month. Things are kind of finally settling down. So back on track:

I assume many of you have seen this, but it’s so important I thought I’d pile on. Researchers from the Graham Center writing in the Annals of Family Medicine report on a more extensive analysis of the interaction between characteristics of family physicians and the associated cost of care with their patients.

The primary issue was comprehensiveness of care provided by the studied family physicians, which was defined by 2 different scales. One included major service categories such as hospital care, ER care, maternity care, pain management, etc. The other scale got into more detail listing more specific service locations, procedures, and office analytic capabilities. NOWHERE ON THESE SCALES WERE ANY OF THE CLASSIC MEASURES OF THE PCMH, ESPECIALLY AS DEFINED BY THE NCQA!!

The population examined was Medicare beneficiaries. The costs were for part A and part B.

The bottom line was — as they had found in a previous study — that there was a very significant correlation between the comprehensiveness of care and reduced total costs of care. The most comprehensive sub-group of family physicians had TEN PERCENT LOWER total cost of care than the least comprehensive group.

To put this in perspective, the most successful ACOs have only lowered the cost of care by one percent or so. The majority have not even “bent the cost curve” (in other words, just slowed down medical inflation). The moderately successful ACOs have merely lowered the annual inflation rate.

This study did not measure quality of care, but I have 2 caveats. One is that the Starfield meta-analysis and others have consistently found that population health is improved in places with more family physicians. Two is that the more time marches on the more I think the quality family physician care is nearly unmeasurable. There are too many exceptions, caveats, and factors beyond the family physician’s control.

Tell your family. Tell your neighbors. Tell your colleagues. Comprehensive family physician care is the best single answer to bring down exorbitant costs of the U.S. healthcare system!

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