Panelists push payment reform for primary care. This is a great title for a blog posting, but is family medicine really moving forward? Will more meetings, more reports, and more blog postings do anything of value for primary care? Since value ratings have become popular, some ratings can be assigned regarding the activities of primary care associations. Good, better, and best value ratings can be assigned to panels, postings, reports, and other efforts.

Good Value Would Be An End to Valueless Distractions and Diversions

Good value would be an end to endless, pointless, and valueless discussions, conferences, or reports regarding building or rebuilding the primary care workforce. It is difficult to maintain primary care with 55% of visits and only 6% of health spending. This is made worse by more burdens as mental health, primary care internal medicine, and general surgical specialties collapse also by payment design.

There is no point to a focus on training interventions until the financial design facilitates the necessary increase in primary care team member positions. Most important for continuity and higher primary care functions is continuity. This requires superior support, not decades of marginal support eroded by higher cost of delivery.

A match of training to financial support has not been seen since the 1965 - 1978 designs. One can do much with a doubling of medical students with the creation and rapid expansion of family medicine supported by a payment design for the elderly and the poor - exactly the places with the greatest shortages.

Since that time primary care has remained stagnant while population growth, complexity, and demand have gone up - and matters are worse where 40% of Americans are most behind.

No additional meeting or report has been needed since COGME III now 25 years past. What needed to be said, has long been said - too few generalists, too few where needed, wrong specialties, unresponsive to needs.

Valueless is more millions spent on reports or gatherings or innovations or primary care home marketing with zero change in primary care delivery capacity.

A Better Rating Requires Much Better Payment Compared to Cost of Delivery

A rating of Better could be obtained by a consistent and top priority focus upon revising the financial design so that we can maintain and expand primary care.


Best Value for Primary Care

Best value for primary care and for family medicine align because no other sources have the incredible value of family medicine for health access overall and where needed.

Best value would be an end to the misguided hoping for improved finances. Best value primary care must focus limited resources only on the best support. Grasping at straws is a far cry from best support.

How many permutations of
  • "no" or "later" or "too little"
  • "let's have another meeting" or "let's have another report" or 
  • "more but at much higher cost of delivery" 
does it take to understand denial and delay seen consistently from all payers involving small, rural, underserved, and especially family practices?

Best value is a family medicine focus on real improvements to stop false hope and to begin recovery and to hope to address health access for most Americans denied by design.

Best value would be an end to pay for performance/value based payments and promotions of same. These claims of Value are not evidence based for improving outcomes and are discriminatory against providers who most care for those most behind. Family physicians are those who most care for those most left behind despite the lack of value demonstrated by decades of payers.

Best value is sadly seen in family medicine with lesser payment along with same or similar outcomes.

Hidden value 
...is family medicine as so few understand that we are the best in scope and distribution, in patient population and complexity, and despite least payment by location and within primary care.

Worst value
...is greatest payment compromise made worse for all of the types of practices that we most represent due to costly regulations and associated penalties. Declines in productivity, increased burnout, higher turnover, increased costs of turnover, and fewer of our graduates remaining in family practice positions all defeat what we represent 


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Robert C. Bowman, M.D.        Robert.Bowman@DignityHealth.org

The blogs represent the opinion of the blogger alone.

Copyright 2017 



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