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A Medicare Administrator’s “To Do” List: the EHR, Chronic Disease Management, Primary Care….
Let’s drop in on a top Medicare administrator as he reviews his “to do” list over a morning cup of coffee.
TO DO
1) George says everybody’s gotta have an EHR by 2014
- tougher than getting a man to the moon in the 60s
- stall — G will be gone by then
2) solve chronic disease crisis
- chronic disease costs are killing us, 5% of seniors account for 50% of costs
- baby boomers hit the fan in 2010
- note to self — drop the cheeseburger at lunch
3) solve primary care crisis
- species could disappear from the continent
- docs are really pissed
- note to self — fire the bonehead that decided to pay specialists 3x more in the first place
4) pick up drycleaning
….etc., etc.
“This is a heckuva list…I wondering if there’s any way to shorten it?
Well, I’ll worry about that after I have my coffee. Let’s take a look at my reading pile.
“Here’s today’s issue of Association of Professors of Medicine (APM) Perspectives. Let’s see what they have to say.
…the fee-for-service payments long prevalent in the United States do not provide support for key primary care functions such as comprehensiveness, coordination, or accountability. Furthermore, most physicians do not have the financial wherewithal to develop the information systems and interdisciplinary teams required for sophisticated interventions to manage chronic illness. There are a growing number of problems caused by the resulting lack of care coordination.
Recent studies suggest rising health care costs may be complicated by the decline in primary care infrastructure. The United States faces rapidly growing numbers of older individuals with multiple chronic illnesses. The benefits of increased access to specialized physicians may be subverted by failures in care coordination among multiple independent specialist offices. Indeed, a survey of consumer experiences with patient safety and quality information recently found that two thirds of respondents felt “coordination among the different health professionals that they see is a problem.” Similarly, in a survey of Medicare beneficiaries, investigators found a decline in the continuity and integration of care by primary care physicians, as well as in the quality of primary care interactions with patients. [Late to the Feast: Primary Care and U.S. Health Policy, APM Perspectives, June 2007]
“Hmmm….what if we tried to combine items 2 and 3 on the list? do ya suppose there’s any connection between the chronic disease crisis and the primary care crisis?”
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The care co-ordination and patient advocacy that is needed can be provided by primary care providers if they have been trained to provide collaborative care and if patients are willing to fund this service privately- ie. as an uncovered/uninsured service.
There is undoubtedly a link between the chronic care crisis, and the “pissed off” docs. This mood extends beyond the primary care docs to include the “cognitive” specialists. I should point out that specialization is not per se the problem for the reimbursement system, it is the relative overweighting of procedures vs. cognitive work. It is also at least worth mentioning that the disease management literature suggests that chronic care costs and outcomes are BETTER under the supervision of specialists. One could argue this has nothing to do with training and everything to do with resources, such as electronic care platforms and multidisciplinary teams.
The overarching challenge to CMS and other payer is that you can’t do #1, #2, or #3 without first tackling payment reform!
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It is definitely a lifestyle change… all areas of your life need to reflect a healthy life style and your correct in having a balanced spiritual, physical and emotional life.