Recently, there has been a tremendous amount of focus and thought surrounding the idea that if patients use primary care more frequently, healthcare costs will improve. The thought is if more time is spent on prevention it will decrease the need for additional expensive interventions over time. Simultaneously, there is also conversations surrounding a shortage of primary care physicians, which in a supply and demand model means the more services you need and the less supply there is, will lead to increased costs. Additionally, there is a focus on addressing the engagement of our primary care physicians who are feeling more and more, overburdened with tasks and activities that do not add value and are taxing on their time.
The theory that primary care will lower costs, itself, is part of a bigger conversation that spending is a product of price and the quantity of services, and thus improving primary care will decrease the number of unnecessary services over time.
As a primary care physician, I wholeheartedly agree with this line of logic, though I believe our present methodology needs refinement for us to be successful. When we discuss the need for primary care, we immediately believe the delivery of such services requires the current distribution model, which is the need for physicians to provide all primary services. Sure, there is a discussion that advanced practice providers can be an alternative, however, this mode of thinking still represents the present paradigm of merely substituting one type of clinician for another.
I believe a much more compelling argument would be to separate primary care services from primary care providers. Doing this allows us to evaluate this issue within two components. 1. How do we deliver primary care services? and 2. What is the best utilization of primary care providers? We need to take this one step further as well, how do we solve the problem of care delivery if studies indicate the number of primary care physicians decreases by one third? Thus it is imperative we address the problem by first defining what we need to accomplish, providing preventive and acute care to our communities at an affordable price, within the context of appropriate resources.
Even with such an approach, we are not addressing all the causes of our present financial dilemma. For instance, this methodology does not address the price point of services nor does it consider administrative waste. Yet, if we shift our focus to reducing the non-added value items that physician fees currently cover such as, labor costs associated with pre certifications, disparate quality metric reporting for multiple payers, the cost of submitting claims, and other regulatory requirements, there may be a reduction in unit prices as our cost of production will be lower.
We need to look at this challenge from many different angles. What is the problem we are attempting to solve; do we solve it within the constraints of our present models or do we adjust our entire construct? Furthermore, we are failing to recognize the warning sign; our consumers are informing us that they cannot afford what we are selling, and our suppliers are burning out. Therefore, let us rethink how to deliver what is needed, and by whom, with innovative ways that will not only enhance the value of what we provide but also simultaneously, bring the joy back to the primary care medical professional.