Beyond the Cottage Industry

As a family doctor with 25 years of experience in the field, I feel strongly that Congress' top priority for health-care reform should be to promote primary care, prevention and wellness. In order to do that, we need to be willing to pay for it. Why do so few medical school graduates choose a career in primary care? Because to do so virtually guarantees a mediocre standard of living. As I reflect on the gulf that grew over the past two decades between primary care and specialist reimbursements, my "root cause analysis" tells me that it's the perverse, piecework payment incentives that continues to promote incredible inefficiency.

I don't believe most folks really appreciate how damaging the current "evaluation and management" codes are, especially as applied to primary care. The only time the doc gets paid is when she sees you, face to face. Forget about chronic care coordination over the phone or by e-mail; those activities almost never get paid for by insurers. And forget about trying to be holistic when the patient does visit; it works out much better for the doc to handle one problem per visit and to not try to mix prevention with problem-oriented care. It's time to strip away piecework payment and instead foster accountable care.

Bottom line: It's time for U.S. health care to grow up - to mature beyond the cottage industry phase of our existence. Every other major sector of our economy has embraced systems thinking, including widespread use of information technology and lean transformation. It's time for health care to follow suit.

By Raymond J. Zastrow  |  June 5, 2009; 2:46 PM ET  | Category:  Health Care Reform , Prevention , Primary Care
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Posted by: STANTONCAROL | June 14, 2009 8:45 AM
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