Grumbach and GAO on primary care crisis
Senate Committee on Health, Education, Labor and Pensions
February 12, 2008
Recent Supply Trends, Projections, and Valuation of Services
Testimony of A. Bruce Steinwald, Director, Health Care
United States Government Accountability Office (GAO)
Primary Care Professionals
Health professional workforce projections that are mostly silent on the future supply of and demand for primary care services are symptomatic of an ongoing decline in the nation’s financial support for primary care medicine. Ample research in recent years concludes that the nation’s over reliance on specialty care services at the expense of primary care leads to a health care system that is less efficient. At the same time, research shows that preventive care, care coordination for the chronically ill, and continuity of care - all hallmarks of primary care medicine - can achieve improved outcomes and costs savings. Conventional payment systems tend to undervalue primary care services relative to specialty services. Some physician organizations are proposing payment system refinements that place a new emphasis on primary care services.
http://help.senate.gov/Hearings/2008_02_12/Steinwald.pdf
And…
The Crisis in the Primary Care Physician Workforce
Testimony of Kevin Grumbach, MD, Professor and Chair of the Department of Family and Community Medicine at the University of California, San Francisco
There are three main points I would like to emphasize:
1. Primary care is the essential foundation of a well-performing health system
2. The primary care infrastructure in the United States is crumbling, and patient access to primary care is suffering throughout the nation.
3. The federal government can address the crisis in primary care through:
a. Targeted health professions primary care training programs such as Title VII programs,
b. Reform of Medicare Graduate Medical Education funding,
c. The National Health Services Corps, and
d. Medicare physician payment reform.
Conclusion
Primary care is essential, and it is in crisis. Decisive action is required by the federal government to avert the collapse of primary care and its catastrophic consequences for the public. Many leaders in the private sector, such as large employers, are already taking action on issues such as physician payment reform to support new models of primary care.
Research provides evidence of strategies that are of proven effectiveness in strengthening the primary care workforce and providing incentives for primary care practice. Some of these strategies, such as implementing a split SGR for Medicare physician payment or reforming Medicare GME payments, do not require new funds but rather a reconsideration of how existing funds are allocated. Other strategies, such as a reasonable level of funding for the Section 747 Title VII Primary Care Training Grants Program, require small investments. For example, restoring Title VII Section 747 funding to its 2003 level of $92.4 million would represent an annual investment equivalent to 0.02% of the annual Medicare budget. Such investments in the future of the nation’s primary care physician workforce are a cost-effective investment in the nation’s health care infrastructure and in the health of the public.
http://help.senate.gov/Hearings/2008_02_12/Grumbach.pdf
Comment:
By Don McCanne, MD
The current dialogue on reform is often more narrowly focused on topics such as disease management and electronic medical records. More attention needs to be directed to reform that would put all of this together: reinforcing our primary care infrastructure.
It is difficult to see how this could be accomplished without significant federal support through expanded policies and public financing. As an example, Kevin Grumbach discusses the very important role that Medicare could play in this process. Those changes alone could arrest the downward spiral of the primary care base. Just imagine what we could do if we were all covered by a single, Medicare-like program.
Reforming health care the right way - who is it that keeps saying this isn’t feasible?