Question

If you had the necessary authority, how would you solve the primary care crisis?

Answer 1

Variety of strategies are being tried to improve primary care access, even without a large increase in the primary care workforce.

Number of patients for a physician can be reduced, depending on the demographics of the patient population (practices with more seniors can see fewer total patients). The physician or nurse practitioner offers same-day and next-day appointments that are as long as necessary, plus prompt access by email and cell phone. Patients receive a comprehensive annual evaluation along with special attention to wellness and prevention.

Different approaches can be made as follows,

• Direct primary care (DPC), an approach that is usually the least expensive but entails seeing more patients
• Membership-based
• Retainer-based
• Concierge medicine (which is more expensive but physicians have fewer patients in their practice)

In most of these models, rather than accepting insurance, primary care practitioners typically charge patients an annual or monthly fee that covers some or all services. DPC allows adequate time per patient, better attention to chronic illnesses, coordination of care when a specialist is needed, 24/7 access, and, most importantly, the opportunity to develop real trust. The result is significantly improved quality of care.

Improving access to primary care will require major macro-level system reform in particular, increases in primary care reimbursement both to reduce the primary care specialty income gap and to invest in primary care practice improvement. However, even with a primary care practitioner shortage, many micro-level system adjustments could improve patients’ ability to obtain prompt primary care services. These could include adding evening and weekend hours, instituting open-access scheduling, increasing the return-visit interval, using e-visits and phone visits, and delegating important but routine functions to nonprofessional staff.

The primary care renewal policy agenda, then, is multifaceted. It is a critical element of any health reform aiming to expand insurance coverage while reducing costs. Coverage expansion and the resultant demand for primary care access presents an opportunity for policy makers to legislate substantial and long-term investments in the primary care infrastructure.