- Joined
- Feb 13, 2008
- Messages
- 545
- Reaction score
- 9
Here is the last one I wrote to my representatives:
According to a Seattle times article I read on the collapse of primary care there has been a greater than 50% decline in medical students going into primary care as specialist physicians often times have salaries 2 to 3 times that of primary care providers. The Medicare Payment Advisory Commission, or MedPAC, which advises congress on medicare in recognition of the primary care crisis called upon Congress to increase payments for evaluation and management by primary care physicians. Medicare reimbursement sets the standard for physician reimbursements through the Resource-Based Relative Value Scale (RBRVS) system which has been heavily influenced by the specialist dominated AMA to overcompensate for procedures. Primary care is an extremely important, albeit neglected part of the health care system. Yet there are not enough primary care physicians entering the system. Most patients value having a primary care physician who knew their medical problems. Furthermore, patients with a regular generalist physician have lower overall costs than those without a generalist physician. In addition, many studies have shown the value of primary care over a fragmented specialty dominated medical system. For example, the finding of the 2008 Dartmouth Atlas of Health Care study of 4,732,448 Medicare patients at thousands of hospitals in the U.S. from 2001 through 2005 found that patients that used two or three times the medical and financial resources than others through undergoing the most aggressive medical care with more tests and procedures, more specialists, and more days in the hospital don't live longer or enjoy a better quality of life than those who receive more conservative treatment. In fact, according to the study,
patients treated most aggressively "are at increased risk of infections and medical errors that come from uncoordinated care, such as doctors prescribing drugs that duplicate or interact with other drugs. They also tend to receive poorer care, spend a lot more money for co-payments, and are the least satisfied with their health care." Compounding this problem is the rise of "midlevel providers" who have significantly less education than primary care physicians yet are being given increasing autonomy through nursing boards rather than the medical boards. Often times the degrees of Nurse Practitioner and now the "Doctorate" in nursing can be obtained on-line with minimal commitment to learning the principlas of medicine as exemplified by 39 hour degree programs with courses including such topics and the "philosophy of science". You had expressed a desire to address the primary care crisis through reforming the reimbursement system that overpays for specialty procedures and underpays for evaluation and management by primary care physicians. As a medical resident who has taken care senior patients with complex medical problems, I am wondering why the recommendations made by the Medpac (the congressional advisory committee on medicare) are not being addressed in either your bill or the proposals of Sen Grassley. Many PCP are limiting the numbers of Medicare patients due to financial burdens they are unable to absorb. I guess my main question is what if anything is to be done to address the severe and continuing deterioration of primary care? Thank you for your time and I eagerly await your response.
According to a Seattle times article I read on the collapse of primary care there has been a greater than 50% decline in medical students going into primary care as specialist physicians often times have salaries 2 to 3 times that of primary care providers. The Medicare Payment Advisory Commission, or MedPAC, which advises congress on medicare in recognition of the primary care crisis called upon Congress to increase payments for evaluation and management by primary care physicians. Medicare reimbursement sets the standard for physician reimbursements through the Resource-Based Relative Value Scale (RBRVS) system which has been heavily influenced by the specialist dominated AMA to overcompensate for procedures. Primary care is an extremely important, albeit neglected part of the health care system. Yet there are not enough primary care physicians entering the system. Most patients value having a primary care physician who knew their medical problems. Furthermore, patients with a regular generalist physician have lower overall costs than those without a generalist physician. In addition, many studies have shown the value of primary care over a fragmented specialty dominated medical system. For example, the finding of the 2008 Dartmouth Atlas of Health Care study of 4,732,448 Medicare patients at thousands of hospitals in the U.S. from 2001 through 2005 found that patients that used two or three times the medical and financial resources than others through undergoing the most aggressive medical care with more tests and procedures, more specialists, and more days in the hospital don't live longer or enjoy a better quality of life than those who receive more conservative treatment. In fact, according to the study,
patients treated most aggressively "are at increased risk of infections and medical errors that come from uncoordinated care, such as doctors prescribing drugs that duplicate or interact with other drugs. They also tend to receive poorer care, spend a lot more money for co-payments, and are the least satisfied with their health care." Compounding this problem is the rise of "midlevel providers" who have significantly less education than primary care physicians yet are being given increasing autonomy through nursing boards rather than the medical boards. Often times the degrees of Nurse Practitioner and now the "Doctorate" in nursing can be obtained on-line with minimal commitment to learning the principlas of medicine as exemplified by 39 hour degree programs with courses including such topics and the "philosophy of science". You had expressed a desire to address the primary care crisis through reforming the reimbursement system that overpays for specialty procedures and underpays for evaluation and management by primary care physicians. As a medical resident who has taken care senior patients with complex medical problems, I am wondering why the recommendations made by the Medpac (the congressional advisory committee on medicare) are not being addressed in either your bill or the proposals of Sen Grassley. Many PCP are limiting the numbers of Medicare patients due to financial burdens they are unable to absorb. I guess my main question is what if anything is to be done to address the severe and continuing deterioration of primary care? Thank you for your time and I eagerly await your response.
