Rallying One Hundred for Health Access Not MACRA

As over one hundred medical organizations make substantial comments regarding the MACRA implementation, perhaps it is time to reflect on the reasons. More importantly is may be the time to focus 100+ medical organizations on some real changes in health care, such as rebuilding a real health access foundation for health care.

It is quite easy to see why so many react to MACRA - flawed in so many foundational ways.
With so many expressing the same concerns, perhaps it is time to build a coalition that will address what AAFP indicates is important as in their words:

Since over half of family physicians are impacted, AAFP could be stronger in their concerns. Since the family physicians impacted are the heart of care where needed, AAFP should be demanding major changes based on its advocacy for the patients threatened.


The Priority of Payment - Higher Payment
as Dictated by Increasing Demand and Stagnant Supply


The most simple route to provide this support, the support needed to withstand this current and future attack of the aggregators, is to increase office, cognitive, basic services payments. No less than 40% of the American population awaits a route to actually use their past, present, or future insurance - or even get basic care. This is because of payments kept low by CMS made worse by forced higher costs of delivery. This is the obvious reason for the rapid rise of concierge care, retail care, urgent care, and direct primary care as well as overuse of emergency care, specialists, and hospital care.

True advocates of primary care must rally to the end of more support. It is also the only way to accomplish efficient and effective care and many of the objectives of CMS as well as AAFP and other families of family medicine. CMS clamped down on payments long ago with compromise set in the design for all those providing office, cognitive, and basic services. Our access barriers are caused by CMS design.

Primary care was asked to respond and was never given the fuel to be able to respond, and got devalued due to lack of response - and the leadership of primary care has tolerated this.

There is also more at stake than can possibly be measured. The very value of primary care itself is at risk. The marginalized primary care due to CMS design can only get worse with further prevention of market forces influence.

The Health Access Solution is more team members in more practices and more places across more hours reaching out to more of the population - regardless of insurance coverage. Only more dollars specific to the support of team members delivering the care works for this end.

Dollars for software, hardware, maintenance, and other non-delivery costs are distractions away from health access. Even worse, health access will be worsened by payment penalties for those caring for the complex and disadvantaged where CMS patients are concentrated resulting in grossly insufficient payment to the tasks of primary care.

HITECH to MACRA has devalued EHRs by subverting market forces and preventing innovation and improvement.

CMS has similarly impaired primary care by designs by subverting market forces and paying too little for primary care with limitations resulting in insufficient primary care workforce and worsening access to basic care.

The solution for better EHRs is market forces - forcing vendors to revise and relate. See How to End MACRA, Meaningful Use and ONC Certified EHRs Programs By HAYWARD ZWERLING, MD  (What should be in EHR by Zwerling)

The solution for better primary care is market forces - driving payments higher and supporting more primary care team members in more places with substantially more basic health access.


Valuing Family Medicine with More Graduates and More Family Physicians

It is frustrating that Family Medicine Families do not see the specific threats or see the need to demand market forces for MACRA and for primary care payment determination.

Only more dollars specific to the support of team members will influence more to choose family medicine and to remain in family medicine. This requires a major increase in payments as well as a major decrease in the cost of delivery. These costs are not going to be made better by absorption into larger groups led far away by those who do not know local people, situations, and conditions.

Decreases in administrative burdens and increases in support are indeed the solution for productivity, morale problems, attracting more to primary care, and keeping more withing primary care and family medicine.

Family physicians have long been resistant to the morale problems of other specialties. But our kind has specifically been singled out. Whether this was intentional or unintentional does not matter, but the front lines of health access are at stake across primary care, mental health, and basic services.

You can bet that further deteriorations will not help our nation and its leaders to value primary care or health access for further decline by design.

Real Solutions Are People Interacting With and For Patients 

Government should focus on supporting those who deliver care and should avoid compromising support for those who care.

Recent Posts and References 

The Ultimate Government Health Care Paradox - Government must facilitate better EHRs and better health access, not prevent them.
Talk About Unpaid Stressed and Abused For Decades - a journalist wakes to health care abuses, but then there is primary care. 
No Positive Spin for the Innovator Tailspin - more claims for innovation successes are apparently attempts to hide failure

Population Health from Above or Below  - population health must not be another new crop to harvest for consultants, associations, and institutions. In must remain about the health of the population, not the wallets of those already doing best.
Stop the Promotion To Restore Mental Health Access - claims of mental health care reforms or improvements are a stark contrast from the reality of lowest payment, highest complexity of care, unreliable payment, and poor support other than lots of rhetoric




Primary care can be recovered and should be recovered, 
but cannot be recovered when moving the wrong directions

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

The blogs represent the opinion of the blogger alone.

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