Peter Sherman, M.D., ACU President, responded to questions about his recent article, “The Primary Care Crisis and Health Care Reforn, published in the Journal of Health Care for the Poor and Underserved, Nov. 2009. Use this link to access the full article (PDF).
Q. Your article documents shortages among primary care physicians, nurses, mental and oral health care practitioners and pharmacists. What aspects of health care reform are most promising in terms of helping overcome these shortages?
A. The House bill includes several provisions to strengthen the National Health Service Corps (NHSC). It would increase funding, create a part-time service option for half of the reward amount, and increase full-time awards from $35,000 to $50,000. For areas not designated Health Professional Shortage Areas (HPSAs), the House proposes to create Frontline Providers Loan Repayment Programs with 90% of awards for primary care providers. The House also includes primary care training and enhancement grants for interdisciplinary training under Title VII. Similarly, the Senate bill permanently reauthorizes NHSC, Title VII, and Scholarships for Disadvantaged Students. The Senate bill also supports primary care health professionals by funding primary care extension programs to educate and provide technical assistance about evidence-based therapies, preventive medicine, health promotion, chronic disease management, and mental health.
Q. In 2008, only 17% of medical student chose primary care as a career path. How do you see that changing if health care reform is passed?
A. Preserving and strengthening the NHSC demonstrates support for primary care, especially in underserved areas. Since both the House and Senate bills would add tens of millions of low-income persons to Medicaid, it is absolutely critical that Medicaid payments to primary care be increased to at least 100 percent of Medicare rates to ensure that primary care physicians will be able to afford to accept new Medicaid patients in their practices. Both bills would provide additional “bonus” payments to designated services by primary care clinicians.
Q. The concept of a patient-centered medical home is very appealing. What are the biggest obstacles to this type of care delivery?
A. While we believe that the patient-center medical home (PCMH) is a great model for coordinating care across the disciplines in order to achieve good health outcomes for our patients, most health professionals receive no or little training in transcending professional silos. And current reimbursement mechanisms fail to bundle payments to encourage transdiscplinary delivery of care. Both the Senate and House acknowledge this and would expand pilot-testing and implementation of the PCMH under the Medicaid and Medicare programs and by qualified private insurers.