The ongoing relationship between primary care physicians and their patients forms the foundation of good health. Although that relationship has survived over the decades, cracks are appearing in it — the result of decades in which Medicare and other payers have devalued primary care by paying more for tests and procedures than for primary care visits.
To make matters worse, Medicare has placed excessive administrative burdens on primary care physicians that hinder the delivery of quality patient care and add to the cost of care.
An announcement last month offers good news for patients and their primary care physicians. The Centers for Medicare and Medicaid Services issued a rule to greatly improve payments for office visits — sometimes called evaluation and management services — and reduce the time physicians must spend on unnecessary documentation that takes away precious time from caring for their patients.
Medicare has undervalued the primary care services provided by internal medicine physicians, family physicians, and other frontline physicians for decades. In addition, unreasonable documentation requirements to justify payment make it harder for primary care specialists to balance caring for their patients and meeting the demands of their paperwork and electronic record tasks; they either keep doctors away from the exam room or focused on the computer and away from directly interacting with patients.
Patients want to spend more time with their doctors; they want to know they are receiving the quality care they deserve. The final 2020 Medicare payment rule would help do that. These long-awaited changes will not only help patients by allowing physicians to spend more time with them, listen to their concerns, and result in better care, but will also make it more attractive for physicians to pursue careers in primary care.
The U.S. is facing a shortage of primary care physicians. CMS’s new rule is an important step toward reversing that trend at a time when an aging population needs more primary care physicians, not fewer. Studies unequivocally show that access to primary care physicians is associated with better outcomes, increased longevity, lower costs, and reduced preventable hospital and emergency room admissions.
As primary care physicians practicing on the front lines of medicine who see the negative impact on our patients of documentation burdens and the undervaluation of primary care, we strongly urge Congress to ensure that the improved evaluation and management policies that CMS finalized are not weakened or delayed before they are implemented on Jan. 1, 2021. Some specialties are opposing Medicare’s final rule because it redistributes payments from procedures to primary care visits, and are urging Congress to block them. We believe that the proposal as it stands will best serve our health care system, and any changes to it will undermine ongoing improvements to patient care.
We believe that this historic regulatory improvement to Medicare will begin to repair the foundation of patient care by shifting the relationship back where it belongs: between the patient and the physician, not the computer and physician. Surely this is something both sides of the political aisle can get behind.
Robert McLean, M.D., of New Haven is the president of the American College of Physicians. Gary LeRoy, M.D., is the president of the American Academy of Family Physicians. This opinion appeared first in STAT on Nov. 22, 2019.
Great article but does not go far enough. Primary care doctors should receive a substantial reimbursement for seeing their patients in the hospital. When I was an intern, we cared for private patients and coordinated with the patients’ internists. These doctors not only knew the patients’ medical problems, but understood their social and family dynamics. Most important, they were trusted.
Now hospitalized patients are cared for by hospitalists. Don’t get me wrong, these doctors are well-trained, but they do not know that patients like their internists. I suspect we would see much fewer readmissions and much happier patients if the primary care doctors were well compensated for seeing in-patients.
Leave a comment