Physician-researcher sees promise in five-year “prospective payment” experiment
By Alvin Powell, Harvard Staff Writer
Many health experts say that U.S. primary care is in crisis, with demand for appointments rising and doctors scarce. A new five-year experiment might prove part of the solution.
Set in motion by Affordable Care Act provisions intended to boost financing innovations, the program, ACO PC Flex, will increase primary care spending while incentivizing doctors to use the funds to head off serious illness and expensive hospital visits. The goal, proponents say, is a healthy cycle of better, broader primary care options.
Soleil Shah, a policy researcher and physician at Harvard-affiliated Brigham and Women’s Hospital, co-authored a recent opinion piece on the new initiative in the Journal of the American Medical Association. In this edited conversation with the Gazette, Shah outlines some of the barriers to primary care and details the potential benefits of ACO PC Flex.
What’s wrong with U.S. primary care?
There are a few different factors at play. First is the burden placed on clinicians to see a lot of patients in a short time. This is getting worse. More often than not, primary care practices are owned by large corporate entities like health systems and insurance companies. These corporate entities want clinicians to see as many patients as they can because more volume means more people can be charged.
Second is that reimbursement is quite low for primary care relative to other providers. Our healthcare system prioritizes specialist care and overweights quick office procedures — dermatologists who perform procedures in the office, ophthalmologists who perform cataract surgery — over primary care, whose doctors do annual exams, provide preventative care, and work up acute medical complaints.
Another issue is the volume of medical information that exists today. It’s a lot for anyone to handle, and as data and knowledge grow exponentially, the scope of primary care is expanding rapidly.