Friday, March 7, 2008
MedPAC, Primary Care: Twidling the Dials.
MedPAC has just released recommendations to Congress about physician payment.
The Disease Management Care Blog finds it interesting that the Commission's report:
1) uses Medicare beneficiary access to care as the fundamental gold standard of payment adequacy. Other peer reviewed evidence as well as physician grexing are important, but much less so. Basically, if Medicare beneficiaries, according to the MedPAC surveys, get the care they need, what’s the problem?
2) focuses on the a) physicians and b) their payment as the primary engine that drives the content of care. That stands in depressing contrast to all those other broader highfalutin strategy proposals to foster novel systems of care.
As a service to its readers, the DMCB humbly offers up this capsule summary on the primary care dimensions of this MedPAC tome:
Access, according to the beneficiary surveys, has clear sailing but there are storm clouds ahead. While not a statistically significant finding, 30% of the ‘10% of the beneficiaries who looked for a new primary care physician’ reported there was a problem finding one, vs. 24% from the year before. As a result, MedPAC suggests that future payment adjustments may lead to further primary care access problems. The report then has vague references to the options of ‘rewarding' and 'providing incentives' to physicians to provide higher quality care and care coordination, as well as exploring 'design issues' to implement a 'medical home.'
Hmmmm. While Medicare is tied up in a lot of statutory and regulatory language, I think MedPAC could have should shown a little bit more gumption. While I agree with the 'access' gold standard, other corners of the Medicare apparatus seem to be a little bit more inclined toward using its purchasing power to drive real healthcare change. Twiddling the twin dials of a) physician and b) payment may taste safe in the primary care arena but it’s less filling.
[Sigh] C’mon MedPAC. According to the “About” portion of the MedPAC web page, your job is to advise Congress about “issues” not “payments.” Quality access to the full spectrum of care is an issue that deals more with patients with less focus on physicians and payments. Everyone already knows that primary care physicians need to be paid far more for their evaluation and management services, but that ingredient is only necessary, not sufficient. The disease management community knows this and even the latest New England Journal of Medicine points to some other exciting approaches.
And by the way, good luck in trying to figure out just who to pay when it comes to care-coordinating primary care.