Countdown to the 2012 Primary Care Armageddon

There are about 132 days until January 1, 2012 when Medicare will be forced to cut fees to physicians by a flat rate of 29.5%. These cuts have already been enacted by Congress. To prevent this action, the current Congress would need to take action – a major problem with this Congress.

Before the end of the year you will hear much about these cuts and why these should not take place. This has been the case each year for a number of years. The fact of the matter is that many of the physician fees should be cut, but there are some fees that should not be cut. Primary care cuts are a very bad idea at the current time.

Even if Congress does miraculously decide to act in a timely fashion, with time enough to allow those delivering services to prepare (too late already), it is likely to cut fees paid for services in a simplistic way. These cuts will include primary care fees along with all others. Across the board cuts are likely as few in this nation understand important differences such as the difference between primary care and non-primary care.

Non-primary care is the area that has substantially increased the cost of health care in the United States for decades. Soon 20% of our Gross Domestic Product will be health care services. This is best indicated by a doubling of non-primary care workforce each 15 years since 1965. More than a doubling is possible in the next 15 year period. Physicians, physician assistants, and nurse practitioners are two to three times more likely to be found outside of primary care as compared to those inside of primary care.  Non-primary care has also demonstrated that it can maintain profits even with attempts at cost cutting.

Non-primary care services are the services needed by the fewest Americans for only a few years of their lives delivered in only a few locations. Primary care services are those needed by nearly all Americans nearly all of the years of their lives needed in nearly all locations. The reason for primary care problems is that the national design favors the few rather than the needs of nearly all.

Non-primary care interests have been providing ever more services for fewer. Primary care has been forced to do more with less - for decades. Primary care has reached a breaking point. This is not about profits or physicians. It is mostly about what is most important – people in need of primary care.

More Americans than ever need primary care. Seniors will double in numbers in the next 20 years and seniors need two to three times more primary care. With serious deficits of primary care and all sources of primary care moving to fewer remaining in primary care, it is the worst possible timing for any cuts in primary care fees.

Primary care is the area most closely associated with basic access to health care services. US designs have resulted in only one doubling in primary care workforce, from 1965 to 1980. Stagnant primary care delivery capacity has been the rule since this time. Primary care has been associated with health care cost savings although this may be more about increased costs due to non-primary care excesses.

Unlike non-primary care that has many options to preserve and maximize profits, primary care has few options. Primary care has no waste to cut. Primary care budgets are mostly about people who deliver primary care services. Cuts in primary care result in cuts in personnel and cuts in primary care services, or closures of clinics delivering primary care.

Primary care has not increased as those that invest in health care have far better investments to make. Primary care has rarely enjoyed investors or investment capital as primary care does not come close to 30% revenue over the costs of delivering care. Non-primary care services have increased most rapidly because it has attracted the most investors. This is logical given higher reimbursement for non-primary care services. To Understand Workforce One Must Follow the Money.

Primary care spending remains just 5% of total health spending – a pittance compared to the needs of 310 million Americans and barely enough for 140 million – by design.

For 30 years primary care graduates have been driven away from primary care - by design. Rather than a real design for primary care with real primary care spending, the United States has a patchwork of patches. The 1965 – 1970 redesign doubled primary care delivery capacity – for the only time in the nation’s history. The 1990 patch worked for a few years. The 2010 fix never came and is not likely. About every 20 years a fix has been needed for the primary care revenue design because the costs of delivering primary care have gone up faster than reimbursement.

This is the message Congress needs to hear from seniors and from most Americans. This message should be passed out to patients and posted in primary care offices:

If Congress does not act by January 1, 2012 to prevent the scheduled 29.5% cut in primary care reimbursement, this primary care office will have to reduce services or close. Many other offices will be forced to do much the same. Primary care is down to the basics - people serving people. We have no fat to cut. Long ago the designs for health care in this nation forced those delivering primary care to be very dedicated just to deliver primary care.

As your responsible provider of care, we want to inform you of this possibility so that you can make other arrangements if need be. As long as we can, we plan to keep serving you. We hope to keep serving you right here in this office. Whether we are able to do so depends mostly upon you and what you do.

We hope to help you keep having a nice day.