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Pizza or Primary Care?
 There is a
debate raging in California over reimbursement rates for primary
care physicians. California is proposing to pay PCPs $21.40 per
visit. Meanwhile, depending on how you tip, a large pizza with two
toppings costs $25. Something is badly wrong with health care in the
Golden State.
As believers in the importance of primary care, we are
concerned about it. Specifically, three long-term problems with
primary care are as follows:
Primary care is not appreciated by health care policymakers.
There is a huge bias toward procedure-based medicine that puts down
the central role of primary care. But look at where the money goes.
Health care policymakers preach prevention and integrated disease
management, but they don't fund primary care, where highly-leveraged
work is done.
The supply of PCPs is increasingly out of balance with
demand. Medical students opt for higher-paying procedural
specialties or services that offer less demanding lifestyles and
work schedules. Some of this is money; some of it is the reduced
prestige that our society and policymakers attribute to America's
front-line doctors.
Health plans and insurers are making the situation worse. In
a highly-competitive market with pressure for cost control and more
competitive products, many payers are contributing to the problem.
Sometimes their role in the problem is obvious, such as when they
cut already-low reimbursement rates. Low reimbursement rates have
two negative impacts—in the short term, they make the PCP "pick up
the pace" and see more (do more) to cover their costs. This leads to
lower quality and less satisfying medicine. Longer-term, stingy
reimbursement rates send an economic signal that drives down the
supply of PCPs.
Are there practical things that health plans can do? Of
course there are. A visionary health plan CEO might consider these
simple steps:
- Understand the supply and demand for primary care in your
market. Go to Kaiser's www.statehealthfacts.com or call me at
719-339-9803.
- Ask your medical staff and finance staff to work together to
brief you on how your plan treats primary care. Ask them to show
you how an expanded role for primary care could improve quality
and cost of care for your members.
- Ask your state HMO association or AHIP to become active in the
primary care problem. (Don't worry about politics; improving
primary care is a win-win issue.)
We're not
saying raise reimbursement rates. We're suggesting, rather, that you
study the problem and do what makes sense (and we think you'll do
the right thing). In primary care—as in pizza—you get what you pay
for. |
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Coming
Soon... Robert E. Nolan Company's
1st Annual Health Care
Survey
The Nolan
Company is known for conducting important surveys in the life
insurance, property and casualty insurance, and banking industries.
In Spring 2009, we will launch our first survey that addresses
issues impacting the health care industry. More information will be
released soon. |
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Previous
Nolan e-Newsletters Online
Past articles
of Trend Line, as well as Nolan's other e-Newsletters—Bank Statement
and Nolan Spotlight—are now available on our website. Follow the
link below to browse the archives.
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2009 Nolan
Events and Sponsorships
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