The ACP Advocate Blog
by Bob Doherty
Wednesday, March 25, 2009
Why is CBO primary care's "Dr. No"?
Listening to the opening statements of members of Congress at yesterday's Subcommittee on Health hearing of the House Energy and Commerce Committee was a bit like listening to Girl Scout campers sing Kumbaya. Legislator after legislator sang the praises of primary care. Two of the witnesses, ACP President Jeff Harris, MD, FACP, and Dr. Fitzhugh Mullen, shared ideas on how solve the primary care workforce crisis.
The Congressional Budget Office (CBO), though, continues to sing a discordant note. In March 10th testimony to the same subcommittee, the CBO had this to say about the medical home and primary care:
"Savings from some initiatives may not materialize because incentives to reduce costs are lacking. For example, proposals to establish a 'medical home' might have little impact on spending if the primary care physicians who would coordinate care were not given financial incentives to economize on their patients' use of services. Those proposals could increase costs if they simply raised payments to those primary care physicians."
The CBO's view that proposals that raise payments to primary care physicians "could increase costs" misses the point. (The CBO also seems to misunderstand the medical home, but that is a topic for a future blog.) As ACP has pointed out many, many times, there is extensive evidence that the supply of primary care physicians is consistently associated with better outcomes and lower per capita expenses.
There also is solid evidence that increasing pay for primary care, so that it is competitive with other specialties, is a pre-requisite to getting doctors to go into primary care.
Think of it this way:
Higher pay for primary care = More primary care doctors = lower per capita health costs.
The CBO, though, can't seem to get beyond the first part of this equation.
If CBO continues to be the "Doctor No" on the value of increasing pay for primary care, Congress will likely have to find budget offsets (cuts to someone else - most likely other physician specialists) to fund primary care payment increases and the medical home. This, in turn, will increase the political opposition, making it less likely that Congress will enact meaningful reforms to increase primary care pay, expand the medical home, and take other steps to reverse the primary care shortage, leading to higher costs over the long haul.
Today's question: What do you think can be done to get Congress to increase pay for primary care, given CBO's view that "simply" raising payments to primary care physicians will increase overall costs?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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