Primary care is the highest value healthcare service. Family doctors, internists, and pediatricians generate 5% of healthcare spending but they direct 80% of that spending. They are the first point of contact, and they refer patients for expensive tests, specialty visits, and hospital stays. That is the reason most primary care doctors are employed by entities like hospital systems that depend on those referrals. Every other developed country has a healthcare system based in primary care. We use primary care to steer patients toward expensive services.
There is another problem. KFF news is one of the most reliable reporters of health news and they say: “For decades, Medicare has paid hospitals — including hospital-owned physician practices that may not be physically located in a hospital building — about double the rates it pays other doctors and facilities for the same services, such as mammograms, colonoscopies, and blood tests.” This is another reason that independent primary care has virtually ceased to exist.
That is terrible for everyone in the country except for hospital systems. Virtually all my healthcare leader colleagues that are interested in better health at lower cost are convinced that independent advanced primary care is the key to the puzzle. Independent advanced primary care teams designed to provide better care for chronic conditions can dramatically reduce the need for specialty referrals and hospitalizations by keeping you and your employees healthier. That is what we all need, but it does not make more money for hospital systems.
Now there is a bill before congress to make the payment for a service equal regardless of who provides the service. Specifically, independent primary care clinicians would be paid the same amount for an office visit as clinicians employed by a hospital system. Hospital systems are vigorously lobbying against that new law on their own and through the hospital association. These hospital systems have billions of dollars in annual revenue. They have immense financial and political power. In contrast, independent primary care has no leverage. They are much smaller with less money and less influence.
To have better health at half the cost, we must develop independent primary care practices with a focus on chronic disease that consistently deliver optimal medical therapy. This is what this entire site is about. We have proven these teams can reduce hospitalizations five-fold and costs by half. They do that by helping us stay healthier longer. That is great for every voter and patient. It hurts the bottom line of hospital systems and they have proven they do not support developing the systems to improve chronic care management in the outpatient setting. They will never do it.
We have a healthcare system dominated by businessmen. The executives of large insurance companies and hospital systems are businessmen. Their primary concern is the bottom line for their stockholders and hospital systems. Better health at lower cost is great for everyone else, but it is a threat to them. We will never have better health at lower cost within the current system. Everything is hidden. You cannot know the price of the services you receive in advance. You cannot compare prices. Under those circumstances, competition will never work.
There is a more fundamental problem though and the National Academy of Medicine (NAM) explained it in detail twenty years ago. “Our current health care delivery system, which is organized around professionals and types of institutions, grew out of a need to provide primarily acute care rather than chronic care. This is one kind of chasm we have to cross. The health care delivery system must be reorganized to meet the real needs of patients.”
The best and brightest at the NAM spelled this out twenty years ago and we have not made a bit of progress in those two decades. Our system is still arranged around the needs of professionals and institutions. It is designed to address acute care needs rather than chronic care management that prevents acute care needs. We will not have better health at lower cost until we address that fundamental reality. Those professionals and institutions who are winning now will fight tooth and nail to keep their money and power. Good for them. Not good for you.
I am working with dozens of stakeholders across the country to finally begin to address these issues. We don’t have the power and money to change our national priorities. Can you even believe that we taxpayers pay hospitals twice as much for the same service as we do independent clinicians. Hospital systems win when that happens. Everyone else loses. Let your politicians know that you want independent primary care clinicians to be paid at the same rate for Medicare services as those who are employed by big hospital systems. The payment methodology should also be designed to keep patients with chronic conditions healthier.
How can your company have a system that is not arranged around the needs of professionals and institutions? It is possible now! If your community or company owns the advanced primary care team, they determine the priorities of healthcare. There are two systems in the United States that already provide better health for half the cost and that is their model. That is a much more effective way to improve the health of your rural or disadvantaged communities. A small rural hospital can never provide world class rescue services for patients with the acute care need of a heart attack. They can provide world class independent primary care services so that your residents don’t have a heart attack in the first place. They can keep your residents healthier longer. A patient who has had a heart attack and is on optimal medical therapy from an advanced primary care team is ten times more likely to be alive in five years compared with a patient in our usual acute care rescue system. Perhaps more remarkably, their care costs $20,000 per patient per year less. We don’t have to wait for politicians to begin the journey. If your community or employer wants to get started, we can support you in beginning the journey now. We can help employers with as few as five employees.
We used to have a public health care system. Maybe we need to move back to this model.
Like many of us, we have bypassed the rigged system and gone to the direct cash payments for our services. Patients and companies are doing the same. We don’t need to corrupt middlemen to gaslight and plunder us. It’s time to stand up and walk away!