Reformed payment policies that honor the "full scope" of a family physician's work are essential to changing the U.S. healthcare system for the better, according to a leader in the movement to make medicine more efficient and patient-centered.
"How long have these promises of increased payment been made to us?" asked L. Gordon Moore, MD. "Unfortunately, I don't think pay-for-performance is the answer for primary care, because the pay-for-performance checks don't go very far."
Moore spoke Thursday at the 2008 Scientific Assembly of the American Academy of Family Physicians in San Diego. He didn't mince words in discussing the faults of contemporary U.S. healthcare and the subsequent burdens placed upon primary care physicians.
"We just can't wait until 2010 for the rollout of the patient-centered medical home," he said. "We need revolutionary change in our industry. Incremental changes will not work"
Moore has been intimately involved in the growth of the Ideal Medical Practices Project, an effort to make efficient primary care practices that serve as "medical homes" to patients the core of medical care in the United States.
He described the different components of an "ideal medical home," saying it's important for family practitioners to "get the foundation right." In order to give physicians "breathing room" to practice medicine in a patient-centered way, he said, it's critical to reduce overhead and increase access to healthcare.
"Family practitioners should not be working for an organization whose main interest is increasing patient volume and just views primary care as a feeder system (for hospital admissions)," Moore said. He compared the experience of working for such an organization to running on a "hamster wheel."
Even if practicing in smaller settings, Moore said, it's next to impossible for primary care physicians to make a living in places like California or the Northeast, given the high costs of doing business and low reimbursement rates.
"These just aren't good places to practice primary care," he lamented."Unless you run a patient mill, I recommend you not get into primary care in southern California."
New reimbursement policies for primary care must be instituted, Moore asserted. These policies should encourage quality, but also be truly patient-centered.
"We need a system of quality measurement that works for all practices and not just big organizations," he said. "And we must take the patient's perspective into consideration when determining quality. If only 3 percent of the medical home model takes patient input into consideration, it's not really patient-centered."
When developing quality programs and reimbursement models, Moore said policymakers must put an end to the "costly and perverse world of administrative trivia" which "divert physician efforts away from patients."