Physicians have embraced ambient documentation faster than almost any technology before it. But every note it writes carries your signature, and lawyers, auditors and patients are starting to read those notes closely.
|Articles|March 25, 2017
How federal policy has worsened the U.S. primary care shortage
Author(s)Peter C. Cook, MD, MPH
Loud and clear warnings forecasting the current shortage of primary care physicians in the United States date back to the early 2000s.
Advertisement
Loud and clear warnings
Related:
Of almost 12,000
A CNN report summarizing the findings stated that “many [primary care physicians] said they are overwhelmed with their practices, not because they have too many patients, but because there’s too much red tape generated from insurance companies and government agencies.”
In response, one would have expected that policymakers, when assessing the merits of a proposed healthcare initiative or regulation, would weigh the measure’s likely impact on making primary care practice less burdensome. Yet, such consideration was apparently given little weight when the Health Information Technology for Clinical Health (HITECH) Act was passed as part of the 2009 American Recovery and Reinvestment Act. HITECH broadened the authority of the Centers for Medicare & Medicaid Services (CMS) to utilize pay-for-performance (P4P) programs as a means of physician compensation. Needless to say, HITECH’s passage struck a major blow to physician autonomy.
Further reading:
In a 2009 interview, President Obama acknowledged the PCP shortage and the difficulty in attracting physicians to choose a career in primary care, stating: “…keep in mind that the status quo is we don’t have enough primary care physicians. We’ve got to create more primary care physicians. And what we want to do is to provide a powerful set of incentives for more and more young people who are interested in healthcare … to go into primary care.”
Which makes the expansion of P4P through the enactment of the
For the PCPs, CMS’s embrace of P4P didn’t just limit autonomy, it replaced autonomy with compromise and conflict of interest. Some examples of the conflict: Does the physician engage female patients in a discussion of the pros and cons of mammography screening and risk falling short of the threshold percentage required for CMS “reward” revenue? Or does one simply go along with CMS guidelines, limiting mention of evidence raising doubts about the benefits of this screening measure?
How about pursuing tight glycemic control in patients with Type 2 DM, despite evidence suggesting a lack of benefit?
Related:
For years after the publication of evidence outlining the benefit of one-time screening for abdominal aortic aneurysm in men over age 65 who had ever smoked
A 2016 American Association of Medical College (AAMC) report predicted that there will be a national PCP shortage numbering anywhere from 12,500 to 31,100 by 2025.
“This trend is to the detriment of patient access. It is imperative that all healthcare stakeholders recognize and begin to address these issues more proactively, to support physicians and enhance the medical practice environment.”
Given the decisions of policymakers in response to similar warnings over the past decade, such support does not seem likely.
Advertisement
Related to this article
An FAQ for practices closing gaps in both commercial and Medicare programs
So many postnominal letters, so little room on ID badges and business cards.
Why U.S. health care needs more sources of investment, not more restrictions on private equity.
Six questions primary care physicians should ask about indoor air quality in their practices.
Excited for the sunset of MIPS? Brace yourself for a replacement, not a repair. Here are four steps to prepare for it.
What happens to kidney care when Medicare’s CKCC model sunsets and LEAD begins?
Restrictive covenants can force employed physicians to sell their homes and leave their communities for better opportunities. Here's how to narrow geographic, time and termination terms up front.
Advertisement
Advertisement
Trending on Medical Economics
1
AI system outperforms physicians on diagnostic accuracy in Microsoft study
2
Rural Missouri health center that delivers more than 525 babies a year with two OB/GYNs lands $540,000 for obstetric staffing
3
Midterms could give Democrats leverage on Medicaid cuts and ACA subsidies, policy experts say
4
Medicaid work requirements: 44% of members unprepared, survey finds
5