Pillars of primary care

[Guest guest]

The current system of financing health

care makes it very hard to do the right thing in all too many circumstances.

There may be good reasons to limit one or another thing in a practice, but in

general Chad

is right on target.

The pillars of effective primary care are:

First point of contact

Relationship over time

Broad array of services

Coordination of care

While our current system directly punishes

us for engaging in much of this work (care coordination for instance is all

uncompensated and complex work), an ideal system would support our desire to

deliver on the promise of effective primary care.

A key message to keep hammering with your

patients, with legislators, in letters to the papers is that we are ready and willing

to step up our professional obligation if we are afforded the resources

necessary to the work. The work of effective primary care takes time and

tools that are out of reach of our practices because of the woefully inadequate

payment that is focused on “encounters” and the crushing burden of

administrative trivia that includes the incredibly expensive and absurd game of

chasing after huge insurance companies to get them to pay a pittance for

legitimate work.

Gordon

From: [mailto: ] On Behalf Of chadcostley

Sent: Wednesday, December 03, 2008

5:52 AM

To:

Subject:

Re: Solo advice

That doesn't work for me. The whole concept is

comprehensive care, and creating a list of

things I " don't do " both hurts the model and makes practice less

interesting. I'm actively

seeking to add to the list of things I do so that patients can stop getting

bounced around

our healthcare system. Also, I believe the trend toward OB/Gyns being the

primary source

of routine gyn exams is dangerous for women. The reason is that a lot of women

consider

getting their annual gyn exam and mammogram as sufficient preventive

healthcare. When

Ob-Gyns, surgeons by training, pretend to be equipped to provide

" preventive healthcare "

for women things get missed. Colon cancer screening, HTN control targets, etc.

all have

poor performance measures in women in part because a lot of women consider

" their

doctor " to be the OB-Gyn who does their annual gyn exam. There's a reason

that the

system is better at screening for cervical cancer in women with very low risk

for the

disease than it is at preventing heart disease - the number one killer of

women. If by

becoming " micro-practices " we limit our range of services, I think we

risk missing the

point.

>

> Don't do gyn exams. When my sister stopped doing them, it really

saved us alot of

headaches. But I do understand that as cash only, you may want to offer

it--maybe as

part of the annual? We are trying to slowly convert to cash only and are

re-thinking the

issue.

>

>

>

>

> ________________________________

>

> To:

> Sent: Tuesday, November 25, 2008 5:40:32 AM

> Subject: Solo advice

>

> I need some advice. I am opening my cash-only practice in January

and given the

economy

> am realistic about how fast it will grow. I am absolutely convinced

it can be successful,

but

> the ramp up will surely be slower than it would have been a couple of

years ago.

Therefore,

> I'm getting very serious about controlling overhead so I can make it

through the lean

months,

> and perhaps years, it will take to get the practice where it needs to

be. I've not been

overly

> excited about practicing with no support, but the economic realities may

force that

decision.

> So the question - how can a male provider realistically practice solo-solo

without a

> chaperone available for gyn exams, or focused cardiac exams for that

matter? How are

> others solving this?

>

> Thanks -

>

> Chad

Costley

> chadcostley@...

>

>

> ------------------------------------

>

>