Basic Health Access

The list of distractions from True Reform are impressive. For decades True Reform has been specifically avoided as primary care worsens within practices and from outside. The demise is most specifically about the financial design. Unless there is a focus on True Reform, there is little hope for Basic Health Access. This may not make as much sense to those outside of family medicine. Family physicians not familiar with AAFP may also be clueless. If you think that you can fix primary care with more technology, more rearrangements, more types of health professional graduates, or more expansions of training - think again. None of these have any hope of working without financial design changes - major changes. The following are various concepts that dominate the discussions at AAFP and primary care meetings and media releases of associations and foundations and institutions. Members, staff, media releases, programs, and personnel have been reviewed.  There is little about...

Datapalooza is a celebration of advances in digitalization over the past decade. It is a chance to promote ideas, concepts, career opportunities, and merchandise. A call for papers could reward the right author with a publication - and even more attention. An academic approach to Datapalooza would critically consider whether the electronics movement has delivered or diverted with regard to the promises of improved health outcomes. There is good evidence that it has increased costs and has adversely impacted access to care where 40% and increasing proportions of Americans most lack access.  Year after year since 2005 and before, there have been the same promises - lower health care costs, better outcomes, better patient satisfaction, and better team member satisfaction. Year after year it is apparent that there are more costs and complications from digitalization. Health care spending has more than doubled and entirely in areas that have not improved outcomes ...

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...

Triple Aim, innovation, regulation, certification, cost cutting, and other changes have widened the gap between small primary care practices and large practices for the past 37 years. The treatment of small practices and those that they serve will some day be recognized as discrimination by design. Revenue and Collections The financial design for primary care has been an issue since the 1980s. Stagnant payments, increasing costs of delivery, and increasing complexity represent the Triple Threat to primary care. This threat is most prevalent in the smaller practices. 15% higher payment are common in large vs small practices for the same office codes (Medicare Data 2011). This translates to about $65,000 less payment per primary care doctor.  This is shaped by a number of different factors such as being small or rural, not being associated with a hospital, being in the wrong state, and being less organized. Large systems and practices often have 5% annual escalati...