Where is the primary care rescue plan?

[MedicineDoc]

I don't see anything that would significantly incentivize primary care. It's (health care "reform") pretty ridiculous as far as I can tell.

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[DrYoda]

Rescue plan? Smells like a trap!

 

[deleted87716]

I don't see anything that would significantly incentivize primary care. It's (health care "reform") pretty ridiculous as far as I can tell.

The primary care crisis won't be solved overnight. The current health reform legislation is, at best, a baby step.

I'm not sure if non-AAFP members can see this online, so I'll post it here.

Senate Passage of Bill Moves Congress Closer to Enacting Health Care Reform
Legislation Contains Provisions Favorable to Primary Care

By James Arvantes
12/24/2009

The Senate passed a health care reform bill on Dec. 24 after more than three weeks of heated debate. The landmark measure seeks to strengthen the U.S. health care system by expanding coverage and enhancing access to services, while also bolstering the nation's primary care physician workforce. "This bill is a good start," said AAFP President Lori Heim, M.D., of Vass, N.C., in an interview with AAFP News Now. "It does many of the things that we have hoped for. It increases the number of patients who will have insurance and is consistent with our Health Care for All policy."

In a prepared statement, AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho, said the Patient Protection and Affordable Care Act (at the THOMAS Web site, type "H.R. 3590" in the search box after selecting "Bill Number") contains provisions that will prevent private insurance companies from denying coverage to people because of pre-existing conditions or dropping patients from coverage if they get sick.

"With 46.3 million uninsured Americans and another 25 million who have inadequate coverage, the possibility of a bankrupting illness has shadowed people of all ages and in virtually all income brackets for too long," Epperly said. "This bill represents important progress toward removing that threat."

In addition, said Epperly, the legislation "will expand Americans' access to preventive, primary care and -- through national demonstration projects -- help establish the validity of the patient-centered medical home, a cornerstone for a meaningful, comprehensive health care system."

At the same time, he noted, "It will begin to build up our nation's primary care physician workforce by improving payment to primary care physicians."

The legislation would provide a 10 percent bonus for five years for physicians who provide more than 60 percent primary care health services in their practices, a provision that Epperly called "an important step toward signaling to medical students that the nation is committed to investing in primary care."

According to both Heim and Epperly, however, more needs to be done.

"We have a primary care physician shortage, and we need to look at increasing the numbers of family physicians," Heim said.

Although she described the bonus payment for primary care as a positive starting point, "it is not going to be substantial enough to really change medical school students' interest in primary care."

The AAFP has called on Congress to make permanent the primary care bonus payment in the legislation and has urged that it apply to physicians who provide 50 percent primary care health services, not 60 percent, to allow more primary care physicians to qualify for the bonus.

In addition, the legislation does not contain a permanent fix for the sustainable growth rate formula, which has triggered steep reductions in Medicare physician payment rates during the past eight years, although the Senate has pledged to work on this issue.

The bill also does not provide comprehensive tort reform, something the AAFP has long championed. It does, however, include funding for states to explore alternative dispute resolution systems.

Nevertheless, Epperly praised elements in the bill that he said are positive for primary care, especially additional provisions aimed at strengthening the nation's primary care workforce.

For example, the legislation would create a national health care workforce commission and would make improvements to the primary care student loan program. It also would increase funding for the National Health Service Corps and would, in addition, reauthorize Section 747 of Title VII of the Public Health Service Act, the only federal program that provides funds to academic departments and programs to increase the number of primary care health professionals.

"Altogether, these (provisions) will help rebuild the foundation on which a stronger primary care physician workforce can be restored," said Epperly. "They will ease the cost of medical education for students wanting to become family physicians and strengthen the educational programs that encourage medical students to become family doctors."

Senate passage of the Patient Protection and Affordable Care Act means House and Senate conferees will start to work on reconciling the House- and Senate-passed versions of health care reform legislation. The AAFP, for its part, will continue to "communicate with members of Congress so that they are aware of our concerns and, specifically, with suggestions on how the legislation can be improved," Heim told AAFP News Now. "The fight over health care reform is far from over."

Epperly echoed that sentiment in his statement, saying the AAFP would continue to work with lawmakers to address the issues that concern America's family physicians.

"We must move forward with health care reform that provides health care security for patients, an adequate physician workforce to meet their needs and a delivery system that enables physicians to provide high-quality health care," he said.

 

[montessori2md]

How will this work for providers who are working in salary based positions? And is that % based on hours or total reimbursement? I'm thinking an FM seeing quite a bit of OB could fail to hit 60%. If you're a rural FM doing ED shifts, does that count as primary care? What about urgent care moonlighters?

As a student, I think students interested in primary care fear FM primarily b/c of being locked out of the IM specialties. People are afraid that after 10-15 yrs as a PCP they'll want to do something else, or that health care will get so bizarre that PC will morph into something that no longer fits their needs.

 

[deleted87716]

How will this work for providers who are working in salary based positions?

That would be up to their employers.

And is that % based on hours or total reimbursement?

It's based on the percentage of total charges.

I'm thinking an FM seeing quite a bit of OB could fail to hit 60%.

It's possible. The AAFP, AAP, ACP, and AOA are pushing to have it lowered to 50% (see the post below this one).

If you're a rural FM doing ED shifts, does that count as primary care?

No. Currently, hospital charges are excluded from the definition. This is problematic for FPs who practice in the hospital, as well.

What about urgent care moonlighters?

If they're billing the applicable ambulatory CPT codes (which they probably would be - see below) it will count.

From the bill:

(x) Incentive Payments for Primary Care Services

(1) IN GENERAL- In the case of primary care services furnished on or after January 1, 2011, and before January 1, 2016, by a primary care practitioner, in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid (on a monthly or quarterly basis) an amount equal to 10 percent of the payment amount for the service under this part.

(2) DEFINITIONS- In this subsection:

(A) PRIMARY CARE PRACTITIONER- The term ‘primary care practitioner' means an individual--

(i) who--

(I) is a physician (as described in section 1861(r)(1)) who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine; or

(II) is a nurse practitioner, clinical nurse specialist, or physician assistant (as those terms are defined in section 1861(aa)(5));

(ii) for whom primary care services accounted for at least 60 percent of the allowed charges under this part for such physician or practitioner in a prior period as determined appropriate by the Secretary.

(B) PRIMARY CARE SERVICES- The term ‘primary care services' means services identified, as of January 1, 2009, by the following HCPCS codes (and as subsequently modified by the Secretary):

(i) 99201 through 99215. [Ed: outpatient visits]

(ii) 99304 through 99340. [Ed: nursing home visits]

(iii) 99341 through 99350. [Ed: home visits]

As a student, I think students interested in primary care fear FM primarily b/c of being locked out of the IM specialties.

That's nothing new.

Family physicians are generalists by design. However, you have a lot of flexibility. No two family physicians do exactly the same thing, and no two practices are alike.

It's not easy to re-train in another field, regardless of which path you initially choose.

People are afraid that after 10-15 yrs as a PCP they'll want to do something else, or that health care will get so bizarre that PC will morph into something that no longer fits their needs.

There's no guarantee that any given specialty won't "morph" into something that a particular individual finds unappealing. In reality, nobody will have more options in terms of how they can respond to changing times than a generalist.

 

[deleted87716]

A PDF copy of a joint letter from the AAFP, AAP, ACP, and AOA to congressional leaders on 12/8/09 may be found here: http://www.aap.org/advocacy/washing/12_8_09jointPrimaryCareLetterMajorityLeaderReid.pdf

It's five pages long, so I won't paste it here.

 

[MedicineDoc]

I thought that proposed 10 percent bonus was just for those in designated shortage areas.

 

[deleted87716]

I thought that proposed 10 percent bonus was just for those in designated shortage areas.

No.

 

[JaggerPlate]

So part of the incentive to go back into primary care as a physician is also given to the NP, and PAs that everyone fear will take over primary care??? Am I missing something here???

 

[deleted87716]

So part of the incentive to go back into primary care as a physician is also given to the NP, and PAs that everyone fear will take over primary care??? Am I missing something here???

Well, you're missing the fact that mid-levels already provide primary care services (and specialty services, for that matter).

In the case of a salaried mid-level in primary care, the bonus would go to their employer. If I were a family physician with mid-levels in my office (which I'm not), that would be a good thing.

There's nothing in the bill that changes the scope of practice of mid-levels. That will continue to be regulated at the state level. The AAFP's position is that mid-levels should be supervised, not independent. That's also my position.

 

[JaggerPlate]

Well, you're missing the fact that mid-levels already provide primary care services (and specialty services, for that matter).

In the case of a salaried mid-level in primary care, the bonus would go to their employer. If I were a family physician with mid-levels in my office (which I'm not), that would be a good thing.

There's nothing in the bill that changes the scope of practice of mid-levels. That will continue to be regulated at the state level. The AAFP's position is that mid-levels should be supervised, not independent. That's also my position.

Oh sweet. See, I took it the wrong way ... good to know.

 

[Coastie]

[YOUTUBE]http://www.youtube.com/watch?v=Tzx6d5h-5Mg&feature=related[/YOUTUBE]