Viewpoint: Make more money, save U.S. healthcare

September 18, 2009
Joseph E. Scherger, MD
Joseph E. Scherger, MD

Family Physician/ Del Mar, CA

A better future for primary care is right in front of us if we have the courage to change, and indeed we must change.

One key to solving our healthcare spending problem is to invest in primary care to reduce the burden of disease in much more expensive settings, such as emergency rooms and hospitals.

The U.S. healthcare system's fee-for-service productivity model ignores the overall responsibility each PCP takes in caring for patients and all the work that is done outside of visits for optimal coordination of care. Changes to the current care model and reimbursement are crucial to the survival of primary care. Otherwise, existing PCPs will continue to see 100 or more patients a week, and medical students will continue to choose more lucrative specialties.

If PCPs were paid just one dollar a day for each of their patients' care coordination, primary care medicine would be transformed. Assuming that personalized care responsibility and continuous access to communication made a modest 1,000-patient panel size appropriate, that dollar a day would result in $365,000 a year before you even billed for patient visits. That would allow you to scale back your number of visits from upwards of 20 per day to around 10, allowing you to spend 30 minutes or more with each patient.

Consider that traditional practices have gross visit revenues of about $425,000 a year, according to Med Ec survey data. Reduce that to $200,000 a year for lower visit volumes, and the medical home PCP would boast gross revenues of $565,000 a year. With less-than-optimal overhead expenses of 60 percent, your net income would still be $226,000 per physician-slightly above the average income for all U.S. physicians, including specialists, according to Med Ec data. Of course, many more PCPs would need to be trained, but a better care model with greater professional satisfaction makes this ramp-up possible.

If this model becomes a reality, the future of primary care would be very bright. The opportunity is right in front of us if we have the courage to change, and indeed we must change primary care if we are to save healthcare in America.

Joseph E. Scherger, MD, is vice president for Primary Care at Eisenhower Medical Center in Rancho Mirage, California, and clinical professor of Family Medicine at the University of California, San Diego. Send your feedback to meletters@advanstar.com
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