Basic Health Access

The Shared Principles documents have attracted much primary care attention. Primary care associations are signing up to support the principles. These are principles that have existed for generations of general practice and family medicine physicians. They are good principles as with other areas supported by such associations. But it is important to remember that the power for primary care principles is the financial design. Each of the primary care principles requires a better financial design. Each principle has long been compromised by the Triple Threat. The primary care Triple Threat is too little revenue, acceleration of cost of delivery, and complexity increasing in multiple dimensions (practice, population, community, higher functions). This limits what we can invest in practice, patients, team members, and the people of our communities. The same Triple Threat is taking out mental health and general surgical specialties - thrusting even more burden upon the family ...

The Commonwealth Fund claims a mission for access and yet the various studies supported and reported by Commonwealth fall short in access. There are claims of improvements from the 2010 reforms, but access improvements are more than just insurance expansion and Triple Aim. Access to care requires the primary care team members to deliver the care. The failure of access is quite obvious in counties and zip codes where half of the US population has grossly insufficient MD DO NP and PA workforce. The financial model has long been broken with regard to the workforce to provide access in these counties and other underserved settings. You cannot expand access via expansions of worst paying and least supportive plans. You cannot expect Triple Aim to help when it is most costly and least rewarding for the practices that make the difference between some access and none. True health reform must involve an increase in the capacity to deliver care - at the national level and especiall...

It would seem that AAFP supports primary care, but is this really true. Does AAFP do all that it can to increase revenue, decrease costs of delivery, and facilitate the work of the team members who deliver the care? Does AAFP support payment designs that result in financial compromise for family physicians? It is harder and harder to make the case that AAFP stands for primary care.  It is even harder to make the case that family medicine stands for most family physicians.  Family medicine leaders have sent a message to Congress, but the message was not the most specific message for the Best Future of Family Medicine. The message was too long with too many items and poor focus. The message did not take the opportunity to align the best interests of family physicians with areas of interest to politicians (designs favorable to Red Counties and the 40% of family physicians in these counties) A message to politicians from a primary care leader should address primary care...

Workforce discussions, conferences, grants, and articles are reliable in one key area - lack of discussion of the requirements for true reform. The workforce blinders will be on and the focus will be on training interventions - interventions that cannot work because of the financial design. There will not even be discussion of the real reason for maldistribution. The big players have wiped this off of the table either by intention or by lack of awareness. There are so many other better options - for them. They prefer expansions of insurance or expansions of graduates or special innovative payments or special innovative training. Most Americans need and entirely different training design, an entirely different payment design, and most likely both for recovery of their basic access to health. If you understand what is proposed, who proposes the solution, and why - there can be clarity If you understand how payment designs are crafted, those who benefit in top concentrations of workf...