"Alternative payment structures for primary care. Primary care practices that provide comprehensive, coordinated, patient-centered care (e.g., certified medical homes) should be offered an alternative to fee-for-service payment." K Shih et.al. Commonwealth Fund (August 2008)

Primary care is fading away in the current United States health market. Payment rewards volume of services over quality. Primary care can not survive in such a payment environment. Moreover, administrative burdens of billing, justifying services for our patients, responding to unfunded mandates for unproved technology, and reacting to external "report cards" continue to increase overhead costs of the physicians who can least afford them – front line primary care physicians.

While it is unclear which, if any, health care reform ideas will prevail, we hear recurrent themes such as:

• "Insurance for all" that offers whole population the chance at high cost - poor outcome care. Our patients don’t just need insurance for all, they need high quality health care for all.
• “Sound bite” solutions such as care teams , disease management, advanced technology, and practice/medical home redesign that sound good but add little value unless they part of major support for excellence at the front lines of primary care. [For example, claims that health information technology alone can save billions flies in the face of analyses calling for more fundamental changes in which proved technology can fit. Rand 2005; Forbes (Gomes) 12/08]

Just prior to the inauguration the proposal began to circulate among front-line PCPs. (See the comments from 1/15 to 2/14/2009). The purpose of the proposal is to present options that should make US healthcare more affordable, universal, and of much greater quality. It had 3 key components:

1. Salary PCPs based on the population served and the quality of the service.

• Removing PCPs from the fee-for-service mechanism that forces increased numbers of daily visits, fragments care, and distorts delivery toward “more is better”

• Enabling the delivery of population and disease management where it is most likely to be effective – at the front line of care

• Enabling the use of smart yet inexpensive technologies such as efficient email communication with patients

• Greatly reducing administrative burden for PCPs and their patients

• Increasing practice vitality and making primary care an attractive career choice

2. Increase and make transparent “real-time” patient reports of care experiences to improve the quality of care.

• Moving care toward exactly the care our patients want and need

3. Make all Americans entitled to primary care.

• Improving health care quality and affordability

Based on revisions suggested by front-line primary care physicians, the proposal has been summarized into a petition for circulation nationwide.

PLEASE READ AND SIGN THE PETITION THAT WE THINK REPRESENTS WELL THE INTERESTS OF PHYSICIANS AND PATIENTS AT THE FRONT LINES OF CARE.

AFTER YOU HAVE SIGNED, PLEASE ASK 5 ADDITIONAL COLLEGUES TO DO THE SAME.

THE NEXT DEADLINE WILL BE 3/1/09

TIMING IS CRITICAL

CONTINUE