Wall Street Journal healthcare reporter Anna Mathews’ most recent article illustrates the tragic absurdity and fatally-flawed economics of our nation’s primary care system.
Ms. Mathews interviews the physician owner of Westminster Medical Clinic outside Denver, which has embraced the latest fad sweeping primary care – Patient Centered Medical Home, or PCMH. The National Committee for Quality Assurance, one organization offering PCMH accreditation services, defines a PCMH as follows:
The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
Clearly, the goals above are modest – a physician should develop a therapeutic relationship with the patient, and provide the right care in the right setting with good communication with other members of the health care system. Many would observe that the goals above are simply what a physician in practice is supposed to do.
So why the need for PCMH, and why are insurers at least providing lip service to increasing reimbursement for providers who achieve PCMH accreditation?
In reality, PCMH is an attempt to improve outcomes and crowbar “Marcus Welby medicine” back into a primary care system that has been overwhelmed with unnecessary and costly complexity. Yet PCMH certification itself is an expensive and complicated endeavor. In other words, we’re fighting the fire of excessive complexity with the gasoline of PCMH.
Evidence for this conclusion comes from Westminster Medical Clinic – according to the article, it has three doctors and 22 staff. That’s a staff to provider ratio of over 7 to 1. Even allowing for some of those staff providing care, that’s well in excess of the primary care national average of around 4 to 1.
When every doctor seeing patients has to support payroll for seven employees, it should be clear we have a problem.
The heart of primary care is the physician, or primary care provider, having time to spend with patients. That’s time spent with the patient listening, educating, jointly formulating a treatment plan, and providing accountability in followup.
Should a doctor spending time with patients require a staff to provider ratio of 7 to 1? Or even 4 to 1?
Anna Mathews has clearly painted a picture that you should recognize as the elephant in the room – unnecessary overhead in primary care practices that has nothing to do with providing good patient care. The next question is identifying from where this overhead originates. MGMA survey data from 2008 report a national average of 2.7 staff per physician are dedicated to interactions with the third-party payer system – that’s billing, coding, and collections.
Do third-party payers add value to purchasing primary care? Or are they simply a burden that ultimately drive independent medical practices out of business?
Is an insurer offering to pay a physician more money for jumping through yet more administrative hoops a sustainable solution? Or is it merely the last gasp of a business model that’s collapsing under its own weight?
The staff at Westminster Medical Clinic should be commended for fighting the good fight in a complex system, and advocating for the care of their patients. But the perceived necessity of PCMH is a symptom of a much deeper problem in American healthcare. Too often in medicine we confuse treating symptoms of disease with its cure – PCMH is the latest pain reliever that does nothing to address the cancer within.