Opinion: Incentivizing Primary Care Medicine: Just Another Carrot On the Stick

Dr. Adam Tabriz

Can We Improve Health Outcomes By Simply Incentivizing Physicians Under The "Primary Care" Rhetoric?!

Illumination Curated initially published this article on medium!

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Some healthcare leaders believe glamorizing the title of primary care medicine over a medical specialty title such as family practice medicine is the way to go towards solving the healthcare crisis of our time. And that physicians need more funding and payment options to be effective in handling such concerns.

The latter opinion was the citation of a piece published by R. Shawn Martin, executive vice president and CEO of the American Academy of Family Physicians.

The article's author in Medical Economics considers Primary care as the ultimate solution to our current healthcare predicament.

Indeed, the high cost of the American healthcare delivery model is failing the citizens. Still, I could not settle with the author's concept of shifting the health outcome trajectory by merely investing in primary care.

“Because, Primary care has been fundamentally ascertained to be the gatekeeper for patient access to liberal healthcare reserves, critical when contemplating the personalized alternative.”

By no means can quality healthcare be achieved unless the healthcare community comes to terms with the reality of what sets primary care apart from Family Practice, Internal Medicine, or Pediatrics.

Healthcare leaders must uphold that primary care is not a medical specialty. Instead, it is the bureaucratic title driven by managed care to pay physicians relatively lesser for more of the same tasks that other medical things can perform.

I concede with the author's opinion that the value of preventative care to individuals and healthcare has always been an understatement. But its disregard for physician burden, burnout, and suicide has been even more mindblowing. That is the problem of monopoly that has riddled our healthcare policies and the outdated healthcare delivery infrastructure, but not necessarily "virtuously" due to the healthcare financing model per se, as Shawn Martin claims! That is particularly important amidst a value-based physician payment scheme.

But Does Offering Various Incentives Solve Our Healthcare Crisis?

The CEO of the American Academy of Family Physicians proposes a robust incentive plan to accelerate physician transition to the value-based reimbursement model. He bases his opinion on a three-step model, including facilitating investment in primary care, Creating added primary care alternative payment models, and removing barriers to entry to a value-based model by creating an "on-ramp" for physicians.

The author justifies the "On-ramp" strategy by eliminating the one-size-fits-all approach of mandating physicians to use models with which they are uncomfortable. Thus, the leaders must create "Ramp models" that meet them where they are and permits them to build skills and capacity around those models.

Indeed, the three-step plan is intriguing, and I am sure it can be precious. Still, it does not address the actual workload and skillset that accompanies the value-based reimbursement model. And one cannot expect a physician to satisfy the workload and nature of quality determinants associated with the merit-based payment model without costly technologies and human resources. Not to mention, collecting data no matter what kind of "Ramp" is a burden physician must endure under the primary care rhetoric.

Maybe, we need to be more specific on the targets of the investments and what problems those innovations plan to solve!

Using "Alternative Payment Models" to incentivize the physician to work harder and more is the epitome of another healthcare Grandiloquence. Still, to me, it is nothing short of a resemblance to another "carrot on the stick metaphor."

Improving The Healthcare System Is More Than Incentivizing Its Stakeholders.

Primary care is a wastebasket title to devalue physicians by forcing them to become data entry persons for the 3rd party payers.

It is understandable, for whatever reason, that a value-based physician reimbursement system is here to stay unless a new miracle happens in our ever-monopolized domain. The payment incentives alone will further place chains and shackles on physicians, particularly those in independent medical practices, utterly under the name of "Primary care."

Today, the healthcare system needs and deserves more. The modern medical practice has a hybrid infrastructure where virtual encounter matches in-person clinic visit in tandem.

The new infrastructure of medical service delivery is transparent, interactive, and collaborative. One with which every stakeholder can search, find, realize, share, and exchange every service and product irrespective of location and distance.

The new healthcare delivery system is the patient in control of their medical care.

The said environment will create a flexible, robust milieu for physicians to distribute tasks amongst each other based on their roles and responsibilities without interruption in workflow and with the amenity of infinite resources within their reach.

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Adam Tabriz is a Physician, Writer, Entrepreneur, and public health policy, expert. He is an advocate for Personal liberty. The combination of his experience and expertise underlines his passion for advocating true “Personalized Healthcare” and “Healthcare without Borders.” His favorite slogan is: “Peace of mind would come to all people through the universal respect for the basic human rights of everyone”

San Francisco, CA
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