Obama Stresses Need for Primary Care, Calls for Physician Payment Changes

The United States needs to make a greater investment in primary care by changing the current physician payment system and by doing more to reward medical students who choose careers as primary care physicians, according to President Obama, who addressed physicians during the annual meeting of the AMA House of Delegates June 15 in Chicago.

Obama assailed the current fee-for-service payment system as a model that rewards the quantity of care rather than the quality of care. "That pushes you, the doctor, to see more and more patients, even if you can't spend much time with each, and (it) gives you every incentive to order that extra MRI or EKG, even if it's not truly necessary," he said.

The fee-for-service model has "taken the pursuit of medicine from a profession -- a calling -- to a business," Obama said. "You did not enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers -- and that's what this health care system should let you be."

Obama said his administration supports health care reform that rewards best practices and that focuses on patient care instead of the current piecework payment system. "With reform, we will ensure that you are being reimbursed in a thoughtful way tied to patient outcomes instead of relying on yearly negotiations about the SGR (sustainable growth rate) formula that's based on politics and the state of the federal budget in any given year," he said, sparking applause.

Obama then called for reforming the way physicians and hospitals are compensated. "We need to bundle payments so you (physicians) aren't paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead are paid for how well you treat the overall disease," he said. "We need to create incentives for physicians to team up because we know that when that happens, it results in a healthier patient. We need to give doctors bonuses for good health outcomes, so that we are not promoting just more treatment, but better care."

Obama called for greater investments in preventive care to avoid illnesses and diseases in the first place. "Building a health care system that promotes prevention rather than just managing diseases will require all of us to do our part," he said. "It will take doctors telling us what risk factors we should avoid and what preventive measures we should pursue."

Of course, achieving that goal of putting prevention first will require physicians who are trained and dedicated to working closely with patients to improve their health. "We need to rethink the cost of medical education and do more to reward medical students who choose a career as a primary care physician and who choose to work in underserved areas instead of a more lucrative path" Obama said.

"That's why we are making a substantial investment in the National Health Service Corps that will make medical training more affordable for primary care doctors and nurse practitioners so they aren't drowning in debt when they enter the workforce," he added.

Electronic health records also figured prominently in Obama's speech. "It simply doesn't make sense that patients in the 21st century are still filling out forms with pens on papers that have to be stored away somewhere," he said. "As Newt Gingrich has rightly pointed out -- and I don't quote Newt Gingrich that often -- we do a better job tracking a FedEx package in this country than we do tracking a patient's health records."

In a prepared statement, AAFP President Ted Epperly, M.D., of Boise, Idaho, praised Obama for "calling out the importance of primary care as the cornerstone for establishing a high-quality, affordable and efficient health care system that ensures health care for all and the quality of care that all Americans deserve."

"In his speech, the president referenced the key tenets of the patient-centered medical home, including the need for electronic health records, preventive care, team-based care and incentives for doctors to spend more time with their patients," he added.

In an interview with AAFP News Now, Epperly also praised Obama for wanting to change the current physician payment system. "The president was honest and clear that we have to change the system so physicians don't make more money by seeing more patients as opposed to providing high-quality care to patients," Epperly said.

However, Epperly did not agree with all of the president's points. For example, Obama said he does not support caps on awards for noneconomic damages in malpractice cases, a statement that prompted boos from the audience.

"Without caps you really cannot control liability costs well," said Epperly. "That is what is driving up a lot of costs in medicine. Physicians are often forced to practice defensive medicine."

Obama described health care reform as the most important thing the United States can do for Americans' long-term fiscal health. "If we do not fix our health care system," he said, "America may go the way of (General Motors) -- paying more, getting less and going broke."

The president stressed that his administration wants to build on the current health care system by fixing what's broken and preserving what works. "I know there are millions of Americans who are content with their health care coverage -- they like their plan and they value their relationship with their doctor -- they trust you," said Obama. "And that means no matter how we reform health care, we will keep this promise -- if you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period."

Obama defended the administration's proposed public plan option as part of an overall health care reform package, saying it will give people a broader range of options and inject competition into the marketplace. The public plan option is not a "'Trojan horse' for a single-payer system," he said.

"I think Obama made a great case for the public plan option, and that he was absolutely against a government-run, single-payer system," said Epperly. "He wanted to make sure everyone knew that."

Dale Moquist, M.D., of Sugar Land, Texas, chair of the AAFP delegation to the AMA, told AAFP News Now he also was pleased that Obama tackled issues near and dear to family physicians. "He came out strong for electronic health records, preventive medicine and more emphasis on primary care," Moquist said. "He emphasized the need for evidence-based medicine to be available sooner and to be more available to the physician. He basically was asking for comparative research.

"I think the delegation felt the president's speech was refreshing and offers a great opportunity. This was a major address for him, and he was using the AMA annual meeting as to reach out to the medical profession and the people of this country."