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.

Go figure.

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?

1 comment :

furrydoc said...

The most effective way to do this would be to show flaws in the economic analysis of the CBO while providing an alternately comprehensive analysis.

Another, perhaps better way to counter this accusation, would be to accept the validity of the CBO report as economically neutral but promote better health care for the public with the same expenditure.

Remember, our problem is not just that we spend too much of the GDP to take care of America's health needs but we do not seem to get the optimal value for what is spent.

rich the furrydoc