Safety Net Should Sunset and Front Line Access Must Rise

The right wording is important to communicate important concepts such as health access. After decades of marginalization, health access must arise. New terms are required.

Front line is the proper term to combine with access. Front line access communicates the challenges met head on and in the most dimensions.

We do not have "safety net" soldiers, or police, or teachers, or nurses. We have front line human infrastructure active and strong in serving person to person. To protect and serve fits across the front line.

Nets have gaps, are passive, reflect the past, and include some of the largest and most impersonal facilities in the nation. Those largest and with the most lines of revenue benefit from "safety net." Critically important primary care must rise as the front line that it is.

"Safety net" must sunset. 

Front Line Health Access
  • CHCs, RHCs, FQHCs, and FPs all represent the front line of health access. New reports continue to reinforce what we have known for decades. Family practice MD, DO, NP, and PA are the essential workforce for CHCs. It is family practice that is desired and required.
  • Family physicians and health centers are multiple times more likely to provide care where needed, distributing services according to the distribution of the population. Other providers concentrate where workforce is already concentrated.
Front Line Assertiveness
  • Access no longer is passive. Access must reach into homes and communities, working with entire populations.
Front Line Protection and Coverage
  • A true foundation for our health care system must not have gaps, cracks, poor maintenance, or missing foundation across any segment of the population - something tolerated for far too long.
  • Front line coverage should also address a major myth in health care of our time - the assumption that insurance coverage is access. Current insurance coverage for primary care is weak, passive and not capable of empowering primary care to protection, coverage, aggression, and continuity even if every person had coverage
Access is person to person - not an insurance contract, especially current ones.

A leader will find it difficult to articulate a coherent vision unless it expresses his core values, his basic identity…. one must first embark on the formidable journey of self-discovery in order to create a vision with authentic soul.
Mihaly Csikszentmihalyi
Safety net is done. The time for front line health access has come. 
Be proud to be a front liner. Pound the pavement until the entire nation has a front liner as a continuity source of care. 



Recent Posts and References

Experimental Innovation or Basic Infrastructure? Wouldn't it be nice if we actually funded infrastructure and basics instead of trying to substitute innovation or other distractions?

For Better or For Worse in Quality - More for fewer and less for more - thus continues the new innovative designs - same as the old designs

Are We Moving Away from Achieving Value in Primary Care? - Quality is over 60% about the patient, situations, relationships and has very little to do with clinical intervention - but this does not prevent serious exaggerations of "so-called value."

Time for Quality in Quality Studies - The Best Studies from the best institutions and journals have led the nation astray in quality studies and we continue down this pathway.

Pressures Mount for ACA Reforms or Revisions - It has taken too long for critical voices to be heard about the consequences of experimentation plus change that is too quick, too costly, and impairs access to care. Compromise may be most specific to small practice and small hospital settings and those that they attempt to serve.

IOM Should Learn About Social Determinants Not Preach Them - Too many IOM studies fail basic research design tests and often for failing to understand important influences of health care outcomes - like social determinants and patient situations and relationships.

The Federal Cause of Shortage Areas and Access Barriers - It is the Federal Design for payment that shapes the breadth, depth, and locations of shortage areas. It is about concentrations of Medicaid and Medicare patients with lowest payment for health access by federal design.

The Real Kerfuffle - How much chaos can family physicians stand? Why do family medicine leaders avoid the evidence regarding MOC? 

Wrong Way Mental Health - Exploitation and insufficient access have been tolerated far too long.

Medicare and Medicaid at 50 and Beyond - A program that once built workforce, facilities, and health access where there were concentrations of poor and elderly patients now compromises workforce, facilities, and access where needed.

Health Affairs Casalino US Physician Practices Spend More Than $15.4 Billion Annually To Report Quality Measures - Each year US physician practices in four common specialties spend, on average, 785 hours per physician and more than $15.4 billion dealing with the reporting of quality measures. While much is to be gained from quality measurement, the current system is unnecessarily costly, and greater effort is needed to standardize measures and make them easier to report. --- With over $40,000 cost per physician, access will suffer further.

The Shaky and Shady Primary Care Medical Home

Lack of Support for Primary Care Medical Home - Schwenk, Abrams, Jackson and Williams References

PCMH costs of $105,000 per physician per year  - too much to achieve success in access

Critical review of Primary Care Medical Home, proposing ways to actually measure value - something not measured well so far.

A Rough Guide to Spotting Bad Science

IOM Panel Calls for Training in Social Determinants (But Needs Such Training)

Which is worse, IOM calling for training or family practice leaders? Front line family physicians do their work because they are local and have continuity with patients and families to deliver care that integrates social determinants and situations. 

Is the IOM Waking Up?

Declines in Health Care Delivery Despite Increases in Health Spending - If We Keep Accelerating Non-Delivery Costs, We Can Continue to Remain Behind Health Care Demand


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

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