The American College of Physicians believes the US primary care system is nearing collapse, blaming problems with payments to doctors and the fact that young doctors are choosing more lucrative specialties over internal medicine.
The college released proposals on 30 January for sweeping reforms. It warned that, if they were not enacted, “within a few years there will not be enough primary care physicians to take care of an ageing population with increasing incidences of chronic diseases.”
The college called for policy makers to evaluate a new way of financing and delivering primary care, which they have called the “advanced medical home” model.
This new approach would use health information technology and other innovations to provide comprehensive and coordinated preventive care. The emphasis would be on working with patients to manage chronic conditions successfully, rather than merely intervening during an acute episode, something which the current method of reimbursem*nt tends to encourage. Such practices would be accountable and would be evaluated for quality, efficiency, and patients' satisfaction and would be subject to a new model of reimbursem*nt.
In its proposals the college also called on policy makers to make fundamental changes in the way that Medicare—the federal health insurance scheme covering elderly patients—determines the value of doctors' services. It says that Congress and the Center for Medicare Services (which runs Medicare) should provide financial incentives to doctors to participate in programmes to continuously improve, measure, and report on the quality and efficiency of the care they provide. Finally, it says that Congress should change the “sustainable growth rate” formula, which cuts Medicare payments to all doctors when total Medicare spending exceeds economic growth.
The proposals say that college members take care of more patients covered by Medicare than any other specialty group. However, neither Medicare nor private insurers pay their members appropriately, especially for their preventive services, the proposals say. Medicare is the single largest purchaser of health care in the United States.
Medicare greatly undervalues primary care doctors' services, the college says. For example, the scheme pays doctors relatively little for consultations in which they help guide diabetic people to control their blood sugar concentrations and nothing for telephone or email advice, but it pays hospitals $30 000 (£17 000; €25 000) for amputating a diabetic patient's limb. (See editorial, p 314.)
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