Monday, March 29, 2010

Will Primary Care Really Be Promoted Under the New Healthcare Reform Bill?

I knew that the healthcare reform bill contained language to promote better access to primary care and some funding for prevention as well as health education, but I didn't know if these activities would really be significant or just lip service. It appears that as far as primary care access goes, there may be some real improvements funded in the new bill.

I have previously discussed the physician shortage, particularly for primary care. This will clearly get a lot worse with the addition of all the previously uncovered adults accessing the system for the first time. I have also discussed the financial dis-incentives for physicians to choose primary care over highly paid specialties. Massachusetts which has led the country in expanded access to care for its residents reports disturbing numbers. They say that over half of the state's internists and 40% of the family practice physicians have closed their practices to new patients because they are full. Provisions in the new law aim to start turning this around by offering bonus payments to primary care physicians and expanded community health centers.

Only 30% of our physicians practice primary care while 65 million people in this country live in areas that are designated as having a shortage of these physicians. So under the new bill there will be a 10% bonus from Medicare for primary care physicians who practice in these areas. This is a good start.

There will also be promotion of "medical homes" instead of the traditional primary care physicians office. These are designed to help extend the limited number of primary care physicians by making them leaders of a team of primary care health professionals. The team will consist of nurses, nurse practitioners, physician assistants and disease educators. They will work together providing more attention to those who need it most. This innovative approach could have a real impact on taking us from a system that reacts to disease and trauma to a system that truly works to prevent disease and manage it before acute intervention is needed.

Its way too early to say that this new bill is going to be effective, but I am encouraged that it will start moving us in the right direction.

More on this later.

Mark Brodeur

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