Good Better and Best Value in Primary Care Leadership

Panelists push payment reform for primary care. This is a great title for a blog posting, but is family medicine really moving forward? Will more meetings, more reports, and more blog postings do anything of value for primary care? Since value ratings have become popular, some ratings can be assigned regarding the activities of primary care associations. Good, better, and best value ratings can be assigned to panels, postings, reports, and other efforts.

Good Value Would Be An End to Valueless Distractions and Diversions

Good value would be an end to endless, pointless, and valueless discussions, conferences, or reports regarding building or rebuilding the primary care workforce. It is difficult to maintain primary care with 55% of visits and only 6% of health spending. This is made worse by more burdens as mental health, primary care internal medicine, and general surgical specialties collapse also by payment design.

There is no point to a focus on training interventions until the financial design facilitates the necessary increase in primary care team member positions. Most important for continuity and higher primary care functions is continuity. This requires superior support, not decades of marginal support eroded by higher cost of delivery.

A match of training to financial support has not been seen since the 1965 - 1978 designs. One can do much with a doubling of medical students with the creation and rapid expansion of family medicine supported by a payment design for the elderly and the poor - exactly the places with the greatest shortages.

Since that time primary care has remained stagnant while population growth, complexity, and demand have gone up - and matters are worse where 40% of Americans are most behind.

No additional meeting or report has been needed since COGME III now 25 years past. What needed to be said, has long been said - too few generalists, too few where needed, wrong specialties, unresponsive to needs.

Valueless is more millions spent on reports or gatherings or innovations or primary care home marketing with zero change in primary care delivery capacity.

A Better Rating Requires Much Better Payment Compared to Cost of Delivery

A rating of Better could be obtained by a consistent and top priority focus upon revising the financial design so that we can maintain and expand primary care.


Best Value for Primary Care

Best value for primary care and for family medicine align because no other sources have the incredible value of family medicine for health access overall and where needed.

Best value would be an end to the misguided hoping for improved finances. Best value primary care must focus limited resources only on the best support. Grasping at straws is a far cry from best support.

How many permutations of
  • "no" or "later" or "too little"
  • "let's have another meeting" or "let's have another report" or 
  • "more but at much higher cost of delivery" 
does it take to understand denial and delay seen consistently from all payers involving small, rural, underserved, and especially family practices?

Best value is a family medicine focus on real improvements to stop false hope and to begin recovery and to hope to address health access for most Americans denied by design.

Best value would be an end to pay for performance/value based payments and promotions of same. These claims of Value are not evidence based for improving outcomes and are discriminatory against providers who most care for those most behind. Family physicians are those who most care for those most left behind despite the lack of value demonstrated by decades of payers.

Best value is sadly seen in family medicine with lesser payment along with same or similar outcomes.

Hidden value 
...is family medicine as so few understand that we are the best in scope and distribution, in patient population and complexity, and despite least payment by location and within primary care.

Worst value
...is greatest payment compromise made worse for all of the types of practices that we most represent due to costly regulations and associated penalties. Declines in productivity, increased burnout, higher turnover, increased costs of turnover, and fewer of our graduates remaining in family practice positions all defeat what we represent 


Recent Blogs 

How Can CMS Improve Value In the Most Valuable?

Frying Pan to Fire for Red Counties

Demographics Against the Democrats

Exploring Designs Favoring Blue Over Red

Keeping Perspective Is Challenging Because of Turbulent Health Care Design

The Tyranny of Health Care Research

Should Medical Associations Preach Evidence Basis (while not keeping it as in MOC, P4P, true primary care solutions)?

Disregarding Humanity - The Great Health Care Debate Ignored

Losing the Super Bowl Year After Year in Health Care

Focus on Finances Not International Graduates

Start with CHIP to Return to Sanity

Scientists Fail at Science involving Physicians and Politics

Six Degrees of Discrimination By Health Care Payment Design

TeleOutreach or TeleProfiteering

Necessary Rather than Disruptive Transformations

Best of Basic Health Access Blogs

Does Academia Compromise Health Care for Most Americans?


Robert C. Bowman, M.D.        Robert.Bowman@DignityHealth.org

The blogs represent the opinion of the blogger alone.
Copyright 2017 



Actual Health Outcome Determinants and Public Health

Does Anyone Understand that High Cost High Need Patients Are Complex?

Patients Must Be Changed, Not Physicians - Patient and Community Changes Can Address Health Outcomes But Physician Behavior Changes the WrongWay Hurt All of Us



The MACRA Test - Can You Survive the P4P Discrimination?

Time Talent and Treasure to Measure Is Not Quality

Time to Burst the HITECH Bubble

To Follow the Money, Follow the Workforce

Value Failure By Those Who Promote Value

Six Degrees of Discrimination By Health Care Payment Design

Comments

Post a Comment

Popular posts from this blog

Another Fine CMS You Have Gotten Us Into

Perhaps we are indeed back to the time of Another Fine Mess (Laurel and Hardy). In a mad rush to implement innovation and to save all possible costs, CMS is creating complications for people that it is most responsible to protect. As PBS and Ken Burns celebrate the legacy of The Roosevelts, it is tragic to see what has become of over a century of effort involving Social Security, Medicare, Medicaid, and health care equity. The United States has one of the most complex health designs and clearly the various designers often know not what they are doing to others. More cartoons and comedians would find this a ripe area for material if not for the suffering involved. Health and Human Services has a huge role across Social Security and US health care. CMS or the Centers for Medicare and Medicaid Services has a dominant role to play in the design of health care in the United States.  CMS can be progressive or regressive. Interestingly CMS has chosen to appear to be progressive and in
Read more

The Essential True Reform Restores Primary Care and Much More

The list of distractions from True Reform are impressive. For decades True Reform has been specifically avoided as primary care worsens within practices and from outside. The demise is most specifically about the financial design. Unless there is a focus on True Reform, there is little hope for Basic Health Access. This may not make as much sense to those outside of family medicine. Family physicians not familiar with AAFP may also be clueless. If you think that you can fix primary care with more technology, more rearrangements, more types of health professional graduates, or more expansions of training - think again. None of these have any hope of working without financial design changes - major changes. The following are various concepts that dominate the discussions at AAFP and primary care meetings and media releases of associations and foundations and institutions. Members, staff, media releases, programs, and personnel have been reviewed.  There is little about Tru
Read more

Why not inside out empowerment rather than outside in abuse?

Just in from Annals of Family Medicine (Miller, Rubenstein, Howard, Crabtree) Shifting Implementation Science Theory to Empower Primary Care Practices Hope for primary care, generalists, rural health, and care where needed requires a very different perspective after decades of failed designs. Not surprisingly this will need to come from inside of these practices and places. Not surprisingly policies and practices dictated from outside have been not only a poor fit - but have been abusive to the populations most in need of care and the practices that serve them. There is hope from the primary care research community. The perspective must be inside of practice looking out - instead of outsiders forcing changes. Qualitative research explores and discovers and reflects as Ben, Will, and others taught me along with the various rural family physicians interviewed and researched in the 1990s in Nebraska. The current focus on quantitative research has demonstrated little to
Read more