Obama: "We're not producing enough primary care physicians"
A New York Times story this week suggests that the Obama administration understands that a shortage of primary care physicians could undermine health care reform. Family physicians, particularly those in rural and urban areas, know this all too well. Others need look no farther than Massachusetts, where a plan for near-universal coverage has been unfolding over the last three years, to see that without significantly greater numbers of primary care doctors, the
expansion of coverage that Obama has championed is likely
to drive costs higher.
A study last year predicted a shortage of 35,000 to 44,000 adult care generalists by 2025, and that was before expanded coverage was the realistic possibility it seems today.
Federal officials are considering several proposals for dealing with the growing shortage, according to the New York Times article: increasing enrollment in medical schools and residency training programs, encouraging greater use of nurse practitioners and physician assistants, expanding the National Health Service Corps, and increasing Medicare payments to primary care physicians. If the latter has to be done in a budget-neutral way, at the expense of payment to specialists, look for dysfunction in the house of medicine, or worse. “A civil war among physicians seems inevitable,” blogger KevinMD predicts.
Waving a white flag for Red Flags compliance
As if CLIA, OSHA and HIPAA enforcement aren't burdensome enough, the deadline to implement the new federal Identity Theft Red Flags Rule is looming. Your practice may be required to have anti-identity theft measures in place by Aug. 1.
The Federal Trade Commission, which will enforce the new regulations, surprised many in medicine earlier this year by determining that the rules also apply to health care organizations, not just financial institutions and lenders as originally thought.
Whether your practice is subject to the Red Flags Rule depends on whether your practice’s specific billing and collection practices qualify you a "creditor."
“Under the rule, a physician or practice is a creditor if they extend 'credit,' which means they regularly defer payment for goods or services and have covered accounts. A covered account is (1) an account primarily for personal, family, or household purposes, that involves or is designed to permit multiple payments or transactions, or (2) any other account for which there is a reasonably foreseeable risk to customers, or the safety and soundness of the financial institution or creditor, from identity theft.”
In other words, a practice (or physician) is considered a creditor if it does not regularly demand payment in full for services at the time of service.
Practices subject to the Red Flags Rule must develop, implement and administer an Identity Theft Prevention Program that includes four basic elements:
1. Reasonable policies and procedures to identify suspicious patterns or practices, or specific activities that indicate the possibility of identity theft in your practice.
2. Procedures for detecting the red flags you’ve identified.
3. An action plan to follow when a red flag is detected.
4. A plan for re-evaluating your program at least annually to reflect new risks.
The Red Flags Rule requires that the program be incorporated into the daily operations of the practice, that it be clear who is responsible for implementing and administering it and that staff be trained accordingly. The AAFP has developed a PowerPoint presentation to help members and their staff learn about and implement the Red Flags Rule. This is one of several resources available at the AAFP's Identity Theft Red Flags Rule Web page.
Medical-legal partnerships: The biopsychosocial-legal model
Think how useful it would be to have an attorney down the hall ready to help low-income patients with living wills, health care powers of attorney, Medicare problems, disability claims, public housing applications and all the other legal sequelae of disease. Doctors in a growing number of hospitals, residency programs and clinics across the country are finding out just how useful it can be. Medical-legal partnerships are bringing attorneys into the clinical setting to help vulnerable patients cope with the legal dimensions of disease.
The National Center for Medical-Legal Partnerships (NCMLP) lists 81 medical-legal partnerships that are currently serving twice that number of health care facilities across the country. While early medical-legal partnerships focused more on serving children and their families, partnerships are now being set up in family medicine contexts. One of those, the Tucson Family Advocacy Program at the University of Arizona in Tucson, was profiled last year in an Arizona Daily Star article. Other family-medicine-oriented medical-legal partnerships listed by the NCMLP include one in California, one in Iowa and one in Montana. If you are interested in exploring the development of a medical-legal partnership in your area, the NCMLP offers assistance.
Good things happen when we increase access to primary care
ABC News recently highlighted the Mayo Clinic's efforts to increase access to primary care and reduce inappropriate use of the emergency department and urgent care among its employees. Mayo created a new department "for the whole family" that combines family medicine, pediatrics and internal medicine, it invested in six new family medicine centers, it opened an express care clinic in a shopping mall, and it used PAs and NPs to see patients at night and on the weekend.
The result? Between 2006 and 2008, Mayo's insurance costs for its employees increased 0 percent. For the average employer, insurance costs increased 5 percent to 7.7 percent per year during the same period.
ABC News medical editor Tim Johnson had this to say:
"Hooray for the Mayo Clinic, but the trend in the country is going in the wrong direction. Most industrialized countries have a balance of 50 percent-50 percent, generalists and specialists. In this country, it’s 70 percent specialists, 30 percent generalists. We’re heading in the wrong direction. Primary care is going down the tubes in this country, and that means we can never have true health care reform unless we change it."
When asked by anchor Charlie Gibson “Why is primary care so critical to saving money?” Johnson replied:
“Because these are the doctors and associates – nurse practitioners and physician assistants – who know the patient and the family, who follow them, who can therefore make wise decisions about what to spend money on, what not to spend money on, how to use preventive medicine, how to control and coordinate chronic disease, and that all saves money. Costs go down, and quality goes up.”
Watch the video here.
Imagine Family Doctor
ER, the long-running TV drama that raised the profile of emergency physicians, aired its final episode last night. Its introduction in 1994 made many family physicians long for the return of Marcus Welby, MD, the show that popularized family medicine during its prime-time run from 1969 to 1976. As far as we know, there’s no family medicine TV drama in the making, but we do want to point out a new release that you might have missed this week -- Imagine Family Doctor, the video game.
Developed for the Nintendo DS gaming system, Imagine Family Doctor invites young gamers (despite the “Mild Blood” warning, it’s rated E for Everyone) to play as Abbie, a young doctor opening her first medical office in a new city. According to the game site, here’s what they’re up against as they try to “Become the favorite doctor in town!”:
• Be the Town’s Doctor – Meet and care for patients as you learn about their symptoms and medical history. Diagnose patients, and give healing advice and prescriptions.
• Learn New Medical Skills – Learn new techniques from other doctors and receive advice that will help you practice. (Use your stylus to apply casts!)
• Solve the Mystery – Discover and defeat a mysterious virus that is plaguing the town.
• Create and Customize Your Office – Design a welcoming office for your patients to feel comfortable in. Choose the color palette and furniture layout that fit your style.
• Make Friends in This New Town – Interact with a number of different characters like the funny shopkeeper, the clumsy actor, and the Zen Doctor.
If only being a real family doc were this easy. (Where’s the “Get Paid” portion of the game, anyway?) Then again, given the recent match numbers, maybe this is just what the the specialty needs.
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