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Tuesday, January 25, 2011

To reform health care, start by paying primary care physicians more, says COGME report

While Congress continues to be divided over strategies for reforming health care, a government panel has suggested that increasing the supply of primary care physicians -- and increasing their paychecks -- is the most effective way to reduce runaway health care costs while improving quality. "There is compelling evidence that health care outcomes and costs in the United States are strongly linked to the availability of primary care physicians," wrote the Council on Graduate Medical Education (COGME) in its 20th report to Congress on physician workforce and training issues.

The report notes that, as a result of numerous factors including decreased medical student interest in primary care and accelerated attrition among current primary care physicians, there is a growing shortage of primary care physicians. Thirty-two percent of physicians in the United States are primary care physicians (12.7 percent are family physicians, 10.9 percent general internists, 6.8 percent general pediatricians and 1.6 percent general practitioners). "This shortage is especially critical in the context of health care reform objectives that have the potential of adding 32 million newly insured individuals that will only further increase the need for primary care physicians," says the report.

Five recommendations

The COGME report calls for "dramatic" policy changes that would have "immediate effect," and it proposes five recommendations:

    1. Increase the number of primary care physicians from the current level of 32 percent of U.S. physicians to at least 40 percent through new policies and programs.

    2. Raise the average incomes of primary care physicians to at least 70 percent of the median income for all other physicians, and reward practices that change their infrastructure to improve chronic care and care coordination. According to data from the Medical Group Management Association cited in the report, primary care physicians' median annual compensation was $186,044 in 2008 versus $339,738 for physicians practicing in other specialties.

    The COGME report recommends increasing fee-for-service payments to primary care physicians, perhaps by increasing the work relative value unit (RVU) used to calculate the value of CPT codes, offering payment for care coordination activities and offering bonuses for performance improvement. The report praises the Affordable Care Act provision that created a 10-percent bonus in Medicare payments for primary care physicians.

    3. Require medical schools and academic health centers to develop "an accountable mission statement and measures of social responsibility to improve the health of all Americans," and to alter their selection processes and educational environments to support the goal of producing a physician workforce that is at least 40 percent primary care physicians.

    4. Change graduate medical education regulations and significantly expand Title VII funding for community-based training to support the goal of producing a physician workforce that is at least 40 percent primary care physicians. This includes requiring more residency training in outpatient settings. The report acknowledges the Affordable Care Act Primary Care Residency Expansion (PCRE) Program, a new $168 million, five-year program aimed at expanding enrollment in primary care residency programs.

    5. Increase incentives for physicians to serve medically vulnerable populations throughout the country. The report cites the Affordable Care Act's provision of $1.15 billion in funding for the National Health Service Corps to recruit more primary care physicians. COGME also recommends increasing funding for Title VII, section 747, to $560 million in Primary Care Medicine and Dentistry cluster grants and increasing funding for Community Health Centers and Area Health Education Centers.

The report is now with the Congress and the Secretary of Health and Human Services for their consideration.

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