Medical Economics readers comment on the challenges of remaining in independent practice, the advantages of the Patient-Centered Medical Home for primary care, and the shortcomings of the Maintenance of Certification program.
I am writing to thank Craig Wax, DO, for his commentary, “A physician’s toughest choice: Accept an offer or remain independent,” in the December 25, 2012, issue of Medical Economics (From the Board). I am still in private practice-not owned by a hospital or any other organization. It will be 10 years in July since we opened our doors.
I am a small practice with two full-time employees. We all work hard and together. We are all invested in making this practice last as long as possible while navigating this tidal wave of healthcare reform.
We are doing very well and rate extremely highly with insurance carriers as they continually evaluate us on quality care issues/measures. Each carrier has different requirements with some overlap in standards, but not enough to make it easy in any way whatsoever. This is in addition to converting to electronic health records and participating in meaningful use and getting our Patient-Centered Medical Home certification. I am happy to say these ventures are going well, and we are managing to do it with little outside help.
Although I am on staff at two large local hospitals, and although they occasionally reach out to community practices-the few that are left-the help and advice on the processes/logistical part of the above procedures we receive from the hospital systems is limited, because they need to funnel their resources into the vast number of owned practices.
We end up forging ahead mostly alone. So far we are very happy, overworked, and gratified all at the same time.
Like Wax, I am skeptical about how this all may end up. I was out of residency during the period of the late 1990s to which Wax refers, and experienced the Allegheny fiasco that occurred in Philadelphia at that time. The whole healthcare system in the city was turned upside down. It was awful.
A large hospital system purchasing and managing practices? It didn’t work then, can it work now? It was a different platform then, but the same modus operandi -- consolidation and control, private business then versus government business now.
Ultimately, the patients will need to start speaking up. As they get more frustrated with the changes they experience on their end, they will be the voice. Unfortunately, the physicians’ voices aren’t as powerful anymore, or as listened to. In the meantime I am laying low and doing what I do best, taking care of my patients. I have hope that the rest will fall into place.
Thank you for the best wishes to your colleagues in the last paragraph, Dr. Wax. There are a few of us still taking the road less traveled. It is good to hear the support of fellow physicians!
Kimberly Corba, DO
I am writing in response to the letter to the editor in the April 10, 2013, issue from Edward Volpintesta, MD (“Single-payer system would simplify care”). I disagree with his comments regarding the medical home and its value, cost, and amount of work involved. Also, his proposal for a single-payer system and its perceived benefits are not well founded.
The Patient-Centered Medical Home (PCMH) is the direction in which we should be headed, in my opinion. The philosophy of PCMH is very consistent with the basic tenets of primary care, especially family medicine and the residency training we received.
Having a nurse care manager in our office setting has demonstrated the value of an organized, population-based approach to caring for our patients. We have demonstrated in just a short period of time the cost- effectiveness of using a patient registry and the discipline of a PCMH model in improving patient care and outcomes.
A single-payer system would be much like Medicare /Medicaid. If we move toward a single payer monopoly, the already inefficient (and at times ineffective) Medicare/Medicaid-type system will become even more so.
Competition in the marketplace in anything leads to excellence. We physicians need to expect more value for our patients and not succumb to the idea of a single-payer monopoly, but rather demand better from our multiple payer system.
Keep up the strong work, primary care physicians, and continue to lead the way for our suffering but fixable system for present and future generations of physicians.
Stephen F. Staten MD, ABFP
St. Louis, Missouri
After reading the article “Get involved to help end MOC” (Talk Back, January 25 issue) and then Lois Nora, MD’s article (Viewpoint, October 25 issue), I felt it necessary to provide a counterpoint.
As a participant in the MOC program, I understand and agree with the need to “remain knowledgeable and skillful in our disciplines and care about providing safe, evidence-based and compassionate care to patients” (as Nora stated). What galls me is that this program has failed in bringing its mission to fruition.
We have all seen physicians who claim board certification as part of their credentials. I know for a fact that very few patients will inquire to determine the date of the certification. Whatever the excuses given by those who have been ‘grandfathered’ into permanent board status, the fact is that ALL physicians should be required to participate in the MOC program. Since we are all physicians in the end, we should all be held to the same standards.
Robert M. Kleinhaus, MD
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