Basic Health Access

Most Veterans are located in counties distant from Veterans facilities. Veterans facilities are concentrated in major metro areas where highest concentrations of physicians are found. As a visual representation these are mostly Blue Counties. Most Veterans find it too expensive to live in places with highest concentrations of physicians as the housing is highest cost to buy or rent. Veterans clinic locations have extended to other sites, but the widespread distribution of veterans makes this a ridiculous and costly choice. The design for Veterans health care is a poor fit for health access for most Veterans. Triple Threat Hurts Access to Veterans More Veterans are most likely to arise from families, counties, and communities that are average to lower in concentrations. They are most often from lowest concentration counties and they tend to return, and they are joined by Veterans not from these counties. This has to do with housing. Affordable housing is lacking in ...

Recent meetings of family physicians brought up the age old question of expanded scope. Some raised concerns about threats to this scope. As is the usual, what is most important is the context. Where half of Americans are found, there is not a reason to be concerned about scope.    Only in highest concentration settings are family physicians limited - since all specialties other than family medicine concentrate in higher concentration settings.   The competition is less and less of a problem regarding broad scope for family physicians in lowest physician concentration counties. Few of the other specialties remain and many are in decline.    This places more burdens upon the remaining family practice workforce. This comes at a bad time as the practices require more time for documentation and there is less time for expanded scope such as hospital and procedural activities.   As discussed previously in recent blogs, the payment designs ...

Family physicians are the most likely to encounter vulnerable populations. Addressing the needs of these populations requires more team members with better support. The team members are the ones most compromised in the past three decades of payments too low and cost of delivery too high made worse by rapid chaotic change. Family medicine leaders have set up a series of meetings. The track record of these large gatherings is not stellar.  The first of these meetings addressed access. The second of these meetings focused upon vulnerable populations. There is a third planned to address primary care workforce. The result will be more panels, reports, centers, and initiatives. But this will not address access, vulnerable populations, or primary care workforce. When a single area is important to all of the core missions of family medicine associations, this should be the dominant if not the only focus. Reports, Panels, Centers, and Grants are what CMS does when it cannot t...