Undervalued Primary Care Threatens Access To Health Care in the United States

Wednesday, Aug. 14, 2013

Janelle Davis
Public Relations Strategist
American Academy of Family Physicians
(800) 274-2237 Ext. 6253

LEAWOOD, Kan. — Access to high quality, coordinated health care requires an adequate primary care workforce — something the United States doesn’t have as a result of the payment system for primary care services. Faced with a payment system that fails to recognize and pay for the complexity and intensity of modern primary medical care, medical students have turned away from primary care, opting instead for higher paid sub-specialty professions.

And that needs to change, according to Glen Stream, MD, MBI, board chair of the American Academy of Family Physicians, and Marci Nielsen, PhD, MPH, chief executive officer of the Patient-Centered Primary Care Collaborative.

“We need to pay for a system that compensates for quality of care provided within a primary care patient-centered medical home,” said Stream. “But our system currently pays for the number of procedures that may or may not be coordinated with other providers. To a great extent, that’s because payment is determined by a system that has overvalued procedures and undervalued the often time-intensive primary medical care that would prevent the need for those procedures. We’ve seen a great deal of discussion about paying too much for procedures and the waste it creates. While overpayment is a legitimate concern, the real threat to the primary care workforce — and therefore patients’ access to care — is underpayment for primary medical care.”

Nielsen stressed the importance of primary care in an increasingly complex health care system.

“Primary care is the foundation of our health care system,” Nielsen agreed. “Primary care patients often have multiple conditions that require a comprehensive treatment plan and complex coordination of services. But the current way of calculating the value of primary medical care fails to recognize the scale of services or the medical expertise required for their care. If we don’t reinforce the primary care foundation, it will erode and we’ll never see a health care system that provides high quality care, avoids unnecessary care and moves toward affordable care for everyone. Primary care can be paid differently and better without increasing total health care costs.”
The AAFP has advocated for improved valuation of primary care services since a 2006 Medicare Payment Advisory Commission report(www.medpac.gov) called for a panel of independent experts to help the Centers for Medicare and Medicaid Services identify overvalued and undervalued services, and to review recommendations from the American Medical Association’s Relative Value Scale Update Committee (RUC). Since then, the AAFP has supported legislative and regulatory efforts to bring payment for primary care in line with the value it provides to the health care system. Among them have been the Accuracy in Medicare Physician Payment Act of 2013(www.govtrack.us) and primary care payment reforms in the CMS’s proposed 2014 Medicare physician fee schedule.

Such reforms would move toward a stronger primary care physician workforce, according to Stream.

“In today’s primary care environment, it’s common for a physician and his or her team to care for a patient with multiple chronic conditions such as high blood pressure, high cholesterol, diabetes, obesity, depression and sleep apnea in a single office visit,” Stream said. “Such a patient is likely to be taking several medications to manage these conditions. These patient visits are very time intensive due to the complexity and coordination of care required. Primary care physicians should be compensated for the role they play in providing high quality care that prevents the need for more expensive treatment in the long run. It’s better for patients, and it’s better for the health system as a whole.”

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Founded in 1947, the AAFP represents 136,700 physicians and medical students nationwide. It is the largest medical society devoted solely to primary care. Family physicians conduct approximately one in five office visits -- that’s 192 million visits annually or 48 percent more than the next most visited medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.  To learn more about the specialty of family medicine, the AAFP's positions on issues and clinical care, and for downloadable multi-media highlighting family medicine, visit www.aafp.org/media. For information about health care, health conditions and wellness, please visit the AAFP’s award-winning consumer website, www.familydoctor.org(familydoctor.org).