I am responding to the article, “Frustrations of the primary care physician should be a wakeup call.” Having practiced medicine for 25 years as a primary care physician, and accountable primary care physician for the past 10, I understand the demands on PCPs’ time and the pressure to please patients, satisfy documentation/coding requirements, manage care teams, run a practice, and earn a living. However, there are some best practices that can be incorporated to help us physicians get off the fee-for-service hamster wheel and expand our capacity while increasing our satisfaction on our journey into value-based care.
I believe providers should be incentivized to create value for our patient populations. However, we also need the structures, incentives, technology, and workflows to enable us in value-based contracts. This creates a cycle that expands capacity while providing quality care, at reduced cost, for maximum return on health care investment by having all players acting together for population health management. It is because of the economics of gain-sharing in value-based contracts, specifically Medicare Advantage, that we can afford to spend more time with patients — typically 30 minute visits for many seniors — to address potential and emerging issues. When revenue is capitated, we can afford to deliver care through email and video visits.
With the volume of current patients, and given that we are taking on new patients because of the Affordable Care Act, it’s no wonder that patients get frustrated when needs aren’t being met because of resource constraints. Also, when sick, a patient and her family are only concerned about immediate attention and care, which is natural. In these scenarios, patients and providers are frustrated with each other because they’re not working together, and the physician has lost control, autonomy and order. To deal with capacity constraints, involve the whole care team: comprised of the patient, family members, PCP, NPs, PAs, medical assistants and case managers. Provide them with the resources to communicate, such as email, telephonic care, video visits, and patient portals. Data from Kaiser Permanente indicate that as long as the patient thinks the PCP knows what the team is doing, it makes little difference whether the person contacting them is a registered nurse or medical assistant.
Another way to address our frustration is by helping to nurture meaningful, caring relationships with patients. Generally, we enter the field of medicine to provide care in order to keep healthy patients healthy and help sick patients get better. Fostering long-term relationships with patients and families produces a satisfied patient, and it makes me feel like they are my family members: The work is much more meaningful. This is fostered with the evolution of online and smartphone resources that allow PCPs and office staff to maintain virtual contact and information dissemination so that in-person appointments are meaningful, engaging and fulfilling.
By rewarding and encouraging PCPs to engage patients in their health care, the Triple Aim plus one can be achieved: better health outcomes, lower cost, and improved patient plus physician satisfaction.
Tom Doerr is director of innovation research, Lumeris.