Throwing money at primary care problem not a fix, physician says

An increase in workload and a decrease in manpower has left the primary-care profession in tatters and near "crisis point," New York Times blogger Pauline Chen, MD, believes. But what can be done to remedy the situation? Patient-centered and collaborative care programs could be a good start, Dr. Richard J. Baron--a primary-care practitioner himself--told Chen in an interview published this week.

"We are really struggling to find models of care like this one because there's not much money being allocated to research like this," said Baron, whose patient-centered medical home pilot program includes a collaborative care model geared toward improving chronic illnesses. "But programs like the one we are trying to build could have an effect...and maybe with a lot less money involved [than other pilot programs, like ones involving new drugs]."

Baron, who recently wrote a paper published in the May edition of Health Affairs about what his Philadelphia-based Greenhouse Internists practice is doing to lessen its dependence on fee-for-service care, ultimately feels that more money is not the solution to the primary-care problem. "[E]ven as primary-care doctors have complained about the unfairness and inappropriateness of the payment system, we have wound up designing, and to some extent have had to design, our practices around it," Baron said. "Just making it rain more, throwing more money around, won't make those things flourish."

More "protected laboratories" for innovation--aka more pilot programs for collaborative care models--need to be made available to ultimately help doctors in redesigning their practices to emphasize quality of patient care rather than getting paid, Baron believes. 

"There are huge opportunities to do our work more effectively and consistently, but we haven't had the same kind of support," Baron told Chen. "The policy people...have to figure out how to encourage people to unlock themselves and give better value in primary care. They cannot expect that to happen in a system that so punishes people who are trying to do this."

For more information:
- read the full interview at the New York Times
- read an extract from Baron's Health Affairs paper