Governor Deval Patrick has graciously asked for help for ways to rein in Massachusetts’ budget-busting health care costs.
Well, since you asked . . .
Not to say “I told you so”, but this was entirely foreseeable. Any attempt to increase coverage without effort to control costs will lead to no other conclusion.
The only true way to cut costs is to say “no”, and ration care. Government does not have the balls to do that.
The fault lies in a failure to remedy the primary care shortage. Coverage without the ability to find a doctor is worthless. Sure, emergency rooms benefit by seeing more insured patients, but care in that venue is often the most expensive.
Following Medicare’s lead and cutting provider payments will simply lead to an increased number of services, further ballooning costs. Not to mention driving already scare primary care providers into concierge cash-only practices or retirement.
Some have suggesting utilizing mid-level providers. They are certainly useful, but asking them to replace primary care is not the answer. NPs and PAs will readily admit their training is not as comprehensive as a physician’s, which will result in higher specialist and diagnostic test utilization.
Provide incentives that appeal to medical students considering primary care. The NY Times aptly describes the situation students face when considering dermatology versus primary care. The choice isn’t close.
Find ways to keep already overburdened primary care providers from leaving or retiring early.
This isn’t rocket science. The ball is in your court Governor.
Related posts:
- Reforming health care using the Massachusetts model won’t relieve ER overcrowding
- My take: Physician salaries, the Massachusetts trap
- Why nurse practitioners and physician assistants will not solve the primary care shortage
- The Massachusetts’ health plan
- ER visits and health care costs rise in Massachusetts due to lack of primary care access
- Can the Massachusetts health reform plan be replicated nationally?
- Primary care is damn cheap, and can solve our health care woes
{ 4 comments }
Kevin,
I couldn’t agree more that the US is facing a primary care crisis. Reimbursement cuts are regressive for PCPs, the massive drop in US medical graduates going into primary care is a shame and the lack of focus on preventative medicine in this country significantly contributes to rising health care costs.
That said I’m not sure a ’shortage’ of primary care physicians is a major problem facing health care reform efforts in general or Massachusetts’s efforts at universal health care in specific.
Let me be a little more precise. The U.S. has a shortage of primary care physicians in per capita numbers, as compared to other OECD nations and in terms of the ratio of PCPs to specialists. But such deficits have existed for decades; for the entirety of modern American medicine.
Evidence for a recent shortage of primary care physicians is spotty. Organized medicine’s (AAFP, ACP, etc.) self reporting surveys of their members showing any decline in primary care’s numbers are obviously pretty low on the pyramid of evidence. Better data, especially aggregates from payers, shows no such shortage. As the GAO reports,
“A decline in the number of allopathic U.S. medical school graduates (known as USMD) selecting primary care residencies was more than offset by increases in the numbers of international medical graduates (IMG) and doctor of osteopathy (DO) graduates entering primary care”
In fact the per capita growth in primary care physicians outstrips that of specialists.
Don’t get me wrong. As I said above, the US has a primary care crisis and such is contributing to our current health care woes as a nation. I’m just not sure the evidence really implies that part of that crisis is an actual ’shortage’ of primary care physicians. And I don’t think such a point is splitting hairs; I think it has implications for the message of reform that medicine needs to be vocalizing.
remove road details from state and local police…have daily gym in school five days a week…intervene more quickly on situations that may cause a permanent physical or psychiatric disability…have a single payer health care system…utilize health courts to make bad events easier to manage for all involved and reduce costs…
“NPs and PAs will readily admit their training is not as comprehensive as a physician’s, which will result in higher specialist and diagnostic test utilization.”
Well? Which one is it? NPs and PAs resulting in greater utilization of diagnostic tests or incompetent providers overutilizng diagnostic testing under the guise of “defensive medicine” or perhaps to line their own pockets? Perhaps both? Clinical examination appears to be on life support with all manner of service providers turning to diagnostic testing as a crutch. Better to have the initial consult done on the cheap with a NP or PA vs. an allopath or osteopath given that both will result in diagnostic testing.
Not only are the cuts regressive, but Massachusetts has various rules about not balance-billing Blue Shield, not billing more than the limiting charge for Medicare, as a condition of licensure.
(and always hearing that the academic centers find ways to exempt themselves from those rules)
If I were a FP in such demand in Mass., I would imagine I would start getting far more selective about insurances. I suspect it makes little difference there, though.
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