Thoughts about a fundamental shift in the way we compensate physicians, especially primary care physicians:
- Require every American to designate a primary care physician
- Once designated, require that they payor pay that primary care doctor some amount of money, $10-25 pmpm
- In exchange for receiving those funds, the primary care doctor accepts certain minimal responsibilities, including seeing the patient one time per year for a physical (for which a claim will be submitted and separate payment issued to the PCP)
- Being available to triage any acute need (another reimburseable encounter)
- Coordinating any specialist referrals needed by the patient
- Coordinating prescription refills for the patient
- Providing medical records when requested
- Miscellaneous other stuff relating to quarterbacking the patient's overall healthcare
- If the primary care doctor wishes to increase the amount of pmpm payments they receive, they can pursue accreditation by NCQA, AAFP or some other body that they have achieved the goals of creating a "patient-centered medical home."
- PCMH-accredited practices can increase the pmpm payments by some significant amount (at least double...$25-50 pmpm) to reflect a reward for their commitment to providing this level of support to their patients.
- Patients would be allowed to change their primary care physician designation on a monthly basis, via the healthplan's web site....and the payment changes as well.
- There would need to be prior notice to the selected primary care physician that s/he now had a new patient in their panel.
- There would need to be some sort of consolidated registry that doctors and patients could go to to lookup the PCP/patient partnering, and to make changes.
- Doctors should be able to close their panels using this medium so that no additional patients can select them, and there could be some sort of mandated maximum panel size, with the ability to appeal for reopening if the doctor can demonstrate that they are providing quality care and not just marketing for names with nothing behind it.
Where does the money come from? My guess is that the savings to the system as patient self-referral to specialists is reduced would provide the bulk of the savings, but Washington has number-crunchers to prove or disprove that assumption.
This would put a tremendous strain on the primary care base of the nation, but if the system allowed any subspecialist to re-designate him/herself as a primary care doctor, the shifts in practice patterns and "rebranding" of specialists could help absorb demand. And the monthly dollars that are flowing to the "primary care doctors" would allow them to invest in infrastructure, whether midlevel providers or hiring new physicians or other ways of making their patient panels as large as possible.
Once this innovative payment system is adopted, America would see a sea change in a lot of things in healthcare. More doctors would select primary care as their specialty in residency. Practices would reach out to patients so they would select them as their designated PCP or medical home. Practices would have a financial incentive to pursue accreditation as PCMH, to the ultimate benefit of the patients they serve. Many other changes and improvements yet to be imagined.