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    Where is the future of primary care headed?

    The ground is shifting under primary care physicians.

    The election of Donald Trump and the resulting uncertainty over the future of the Affordable Care Act and Medicare is only the latest tremor. The move away from the fee-for-service payment model toward value-based care, new regulatory requirements, the migration of independent practices to healthcare systems, the emergence of new models of care—they’ve all left primary care physicians (PCPs) unsure of what’s to come and how they will be affected.

    And even as primary care struggles to keep its footing, it’s being called on to do more than ever before: coordinate care for an aging population beset by chronic disease, improve the overall wellness of the population, control costs and eliminate waste and fraud. These tasks validate the importance and necessity of primary care, but they present daunting challenges nonetheless.

    “Is primary care going to survive? You bet. We’re going to be very much needed, but it’s morphing,” says Ripley Hollister, MD, a primary care physician in Colorado Springs, Colorado, and a board member of The Physicians Foundation, an advocacy group for better healthcare.

    In fact, after decades of losing control and income to specialists, hospitals and other providers, this could be an opportunity for primary care to retake its position at the center of the U.S. healthcare system, says Joe Flower, a healthcare futurist and consultant.

    “It’s not just whether primary care docs will get more money and control,” says Flower, the author of Healthcare Beyond Reform: Doing it Right for Half the Cost. “It’s whether we rebuild our healthcare system around them.” 


    Decision time

    This will be the year when many PCPs make fundamental decisions that go a long way toward determining their futures. 

    Among the questions to be answered: whether to remain independent, whether to seek reimbursement under the Medicare Access and CHIP Reauthorization Act (MACRA) or pursue a different practice model that would exempt them, such as concierge or direct primary care, and how to retool their practices to align with the coming world of value-based care. Some older physicians may decide to retire earlier than planned to avoid the new regulations and requirements.    

    “There is no one solution for everybody,” says healthcare management consultant David Zetter, CPC, CHBC. He suggests practices familiarize themselves with MACRA and other trends affecting primary care, then undertake a thorough self-assessment of everything from finances and staffing to patient population health and office procedures.  

    That audit will give them a better idea of their strengths and weaknesses and what they need to change to succeed in a value-based care system. 

    Those changes could be significant. For example, Zetter says, practices that have not implemented EHRs will have to do so in order to meet MACRA’s reporting requirements. Others might need to become more proactive in managing patient health through a new emphasis on patient compliance or do a better job of collecting and analyzing patient data. 



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