Saturday, May 02, 2009

SFC Health Care Mess #2: Adding Primary Care Doctors is Like Drilling for Oil

Drilling for oil and training doctors have a long-time horizon. Each requires a decade to have a meaningful impact. President Bush frittered away his eight years opining over OB/GYN's not practicing their love with their patients. Yet, he didn't plan to add one. Bush wanted medical malpractice reform, something the Texas legislature accomplished in 2003.

The Obama administration awoke HHS from its long nap, only to find a projected shortage of 66,000 primary care doctors by 2020 (a mere decade away by the time a bill passes). The Senate Finance Committee (SFC) put doctor training high on its priority list.

They propose a 5% bonus on qualifying payments to primary care doctors. The bonus runs from 2010-2014. It applies to currently practicing doctors and those in residency. How does a 5% bonus makeup the primary care shortfall relative to specialists? It might take a primary care physician from $150,000 to $157,000. That's a drop in the bucket. It also goes away long before 2020.

Busy primary care physicians had to go from seeing 3 patients per hour to 5 to keep their income level under the Bush regime. The government will offer "a modest fee" to doctors for managing non-physicians.

Medicare would reimburse physicians for certain care management activities performed by nurse care managers (or other qualified non-physician professionals, such as diabetes educators). Qualified activities would include providing in-person care assessment and management, coaching, education, and self-management support to patients.

It's a good thing primary care physicians have so much free time. President George W. Bush pushed high deductible health plans so patients could negotiate with doctors over fees. Besides haggling with patients over price, doctors could soon manage non-physicians for a modest fee.

A paltry bonus and added responsibilities won't solve the shortage. What might? The Senate Finance Committee plans to take unused medical residency slots and turn them into primary care or general surgery positions. Hospitals will have three years to fill them.

The problem is medical students are choosing specialty care over primary care at a rate of 6 to 4. That's why there are unused residency slots. Forty primary care residency programs disappeared between 1995 & 2006. What happens after the government reshuffles the deck? Who will apply? The SFC document left an out clause. Unused slots can be converted to another specialty.

Physician payments are slated for a 0% and 1% increase the next two years. After that, they fall between -3 and -6% annually through 2014.

As the Senate plan makes no meaningful changes, my guess is America will raid third world health systems for our primary care physicians. European doctors will shy away from America's new private health care explosion, also known as corporafornication.

Medicare will tighten its credentialing and conditions of participation for doctors. How many physicians will offer their finger prints to HHS for billing privileges? How many primary care docs will retire early to avoid the bloody mess? Will it require more than 66,000 predicted?

Health care deform is coming, courtesy of Mad Max Baucus and Crazy Chuck Grassley. It's a shame they don't want to give physicians a good job to do and pay them fairly.

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