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"We need fundamental reform of our system for paying health care providers--reform that will reward high-quality care and prudent stewardship of resources, move toward shared provider accountability for the total care of patients, and correct the imbalance in payment whereby the provision of specialty care is rewarded more than primary and preventive care." The Commonwealth Fund Commission (November 2008) |
General information
1. If you agree with the general concepts and are generally supportive, please sign the following petition. (Please recognize that the petition is an idea and your signature is an expression of strong support only).
2. Consider adding comments.
3. Send on www. patientsatcenter.org to 5 primary care colleagues and ask them to sign the petition.
4. If we get enough signatures by the first deadline of March 1, 2009, the petition will be presented to the media and congressional sponsors for their consideration. The petition will continue thereafter if warranted by continued interest from primary care physicians
The Petition
Primary Care Physicians and Nurse Practitioners (PCPs) propose that US health care expenditures be divided into two streams:
1. A ”primary health care for all" stream. This stream provides PCPs a guaranteed salary and overhead for providing care to a panel of patients. This expenditure stream would require neither the capitated patients nor the PCPs to participate in complex administrative and billing tasks. Over time, these PCPs would be subsidized to use technology that is proven capable of true "inter-operability" across the continuum of health care. This technology would support highly efficient prescribing, population management, shared decision-making, patient assessment, and information recording. (Examples include patient registries, email communications, etc.) Population-based, health-care experience measures would be required to ensure coverage and quality for all patients.
a. Payment for ambulatory services is guaranteed for 5 year periods and must increase at least at the rate of general inflation.
b. Participating PCPs could negotiate for hospital payments from #2 below if they choose to add hospital coverage as a service.
2. The other expenditure stream would support specialists, PCPs who do not opt-in to #1, pharmaceuticals, non-routine tests, devises, and all costs related hospital care.
a. Financing of this stream would be dependent on “whatever is left” after #1 above and be subject to market and political expediencies.
The expected outcomes are:
Most people would have a PCP.
Patient-reported attributes of high quality primary care will be measured in real time and guide improvement
PCPs will be organized on quality and fair principles of work with clear expectations.
Primary care will be fairly budgeted based on population and overhead principles
The hassles of PCP care will be mitigated by minimizing administrative procedures
The PCP expenditure stream will not be diverted by the interests listed in #2 above.
PCP will become an attractive clinical option to physicians and medical students
PLEASE SEND ON THE ADDRESS WWW.PATIENTSATCENTER.ORG WITH A SUPPORTIVE COVERING NOTE TO 5 PRIMARY CARE COLLEGUES (OR MORE IF YOU HAVE ACCESS TO A MAILING LIST)