AAFP Board Chair Makes Case for PCMH, Primary Care at Small Business Committee Meeting

AAFP Board Chair Jim King, M.D., of Selmer, Tenn., recently urged Congress to adopt the patient-centered medical home, or PCMH, as the centerpiece of the nation's health care reform efforts because a primary care-based health care system will lead to higher quality and lower costs.

King, who participated in a roundtable discussion on health care reform convened by the House Committee on Small Business here on April 28, described the PCMH as a team-based approach to health care that places a strong emphasis on preventive services and chronic care management. If adopted by Congress as part of a comprehensive health care reform package, the PCMH would shift the nation's health care paradigm from a sick-based system to a wellness-based system, resulting in higher quality and significant cost savings, said King.

But to support primary care and the PCMH, public and private insurers have to start paying physicians for providing cognitive services while also rewarding care coordination and health care outcomes, according to King. Under the current fee-for-service system, physicians get paid for providing more services, not better services, said King.

"You have to pay me differently," he told members of the committee. "You can't just pay me for spending five minutes in the exam room." King also told committee members he does not get paid for 40 percent of the services he provides, such as follow-up care and care coordination.

In addition, said King, the current health care system needs to enact fundamental payment reform to reverse growing shortages of primary care providers. He reminded committee members that although Massachusetts enacted a comprehensive health care reform measure in April 2006 that required every state resident to carry health insurance, the state has been unable to meet the growing demand for primary care services with its current supply of health care practitioners. This has created a gap between coverage and the actual provision of services. The rest of the country faces a similar fate without fundamental reform of the current physician payment system, said King.