There is a government move afoot to have primary care doctors “manage” care for everyone with Medicare. The benefits of primary care coordination can be tremendous but must be balanced against the risks. Given the shortage of primary care doctors, requiring primary care coordination could cause patients–particularly vulnerable patients needing urgent care–needless harm.
The shortage of primary care doctors could mean dangerous delays for people who need care urgently and are required to see a primary care doctor before seeing a specialist. It could also mean additional copays and trips to the doctor, which could impede access to care. When primary care doctors work for insurers or private equity firms, as they increasingly do, financial incentives also could pose risks to patients who need specialty care.
The Centers for Medicare and Medicaid Services, CMS, is on a mission to have everyone with Medicare in what it calls an “Accountable Care Organization” or “ACO” by 2030. With ACOs, the government pays entities–sometimes hospitals and sometimes private equity firms or insurers–an upfront fixed fee to treat patients. It’s up to the entity to decide what care to cover and when. They maximize profits when they provide less care.
What could be wrong with an ACO? For now, ACOs are accountable in name only. They are largely unaccountable for the care they provide. The limited oversight of their performance coupled with their large financial incentive to withhold care–they profit more–suggests huge cause for concern, especially when Wall Street entities, private equity firms and insurers are calling the shots.
Accountable Care Organizations, like Medicare Advantage HMOs, can leave patients waiting a very long time to see a primary care doctor. If people need to see a primary care physician in order to get specialty treatment, their conditions can worsen when care is delayed. Stories abound about that happening to people in Medicare Advantage HMOs.
Pre-pandemic, Kevin MD reports that fewer than one in five physicians were taking new patients. More than eight in ten had no ability to see new patients. We are likely to be short 48,000 primary care physicians in the near future.
Of course, the shortage of PCPs would not be as pronounced if doctors spent less time on administrative functions. One study found that about half of a physician’s time is spent on administrative work. Less administrative work would make it far easier for doctors to see more patients. Right now, the US fares poorly relative to other countries in ensuring people see primary care doctors in a timely fashion.
We need to invest more in primary care before insurers and ACOs are allowed to require people–particularly vulnerable older adults and people with disabilities–to see a primary care doctor in order to see a specialist. Kevin MD reports that a lot of unnecessary medical treatment stems from the fact that primary care physicians do not have the time to oversee patient care. A lot of inappropriate delays and denials of care also result from a weak primary care infrastructure and financial disincentives for insurers to provide appropriate care.
Here’s more from Just Care:
- Primary care through CVS? Financial incentives pose a serious concern
- Questions for your primary care doctor if you have Medicare
- Six reasons you need a primary care doctor in this age of specialization
- Four questions to ask yourself about your primary care doctor
- Government is not warning people about Medicare Advantage plans that could endanger their lives
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