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.

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 Comments :

Blogger 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

March 26, 2009 at 1:40 PM  

Post a Comment

Subscribe to Post Comments [Atom]

<< Home

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.

Share/Subscribe

Bookmark and Share

The ACP Advocate Blog

Recognition

The 2009 Medical Blog Awards
Voted Best Health Policy/Ethics Blog 2009

Healthcare Bloggers
10 Healthcare Bloggers We're Thankful For

Blog log

Health Blog
The Wall Street Journal's blog on health and the business of health.

Health Affairs Magazine Blog
The Policy Journal of the Health Sphere.

The Health Care Blog
Everything you always wanted to know about the Health Care system. But were afraid to ask.

MD Whistleblower
Vignettes and commentaries on the medical profession.

The New Health Dialogue Blog
From the New America Foundation.

Kevin MD
Medical Weblog

DB's Medical Rants
Contemplating medicine and the health care system

EGMN Notes From The Road
Bloggers post from medical meetings, press conferences, and policy gatherings from the U.S. and around the world, providing readers with a tasty analysis of the buzz, the people, and the stories that don't get told.

FutureDocs Blog
A blog dedicated to medical education, news, and policy as well as career advising.

Disease Management Care Blog
An ongoing resource for information, insights, peer-review literature and musings from the world of disease management, the medical home, the chronic care model, the patient centered medical home, informatics, pay for performance, primary care, chronic illness and health insurance.

Medical Professionalism Blog
The Medical Professionalism Blog was created by the ABIM Foundation to stimulate conversation and highlight best practices related to professionalism in medicine.

Powered by Blogger

Comment policy & copyright info