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    Your Voice: Physicians can save healthcare

    It has been clear for many years now that primary care practiced in a truly transformed patient centered medical home (PCMH) practice saves the system thousands of dollars. 

    In my own PCMH, we have reduced hospital admissions by 80% over a five-year period, not to mention ED visits. I don’t remember the last diabetic ulcer I have treated because of the good care we give diabetics in our NCQA-certified diabetic center of excellence. I could go on and on about the successes.

    Unfortunately, the federal government and large insurance entities are giving lip service to these PCMH settings, but not reimbursing them. There is a significant overhead cost to provide these advanced levels of care, and these highly functioning clinics are soon going to collapse because reimbursement is not supporting their infrastructures.

    Every patient in the U.S. should have a primary care physician in a highly functioning medical home—that is how to save the healthcare system. 

    We need to be the gatekeeper. How many times have you seen patients on the subspecialty treadmill seeing multiple subspecialty physicians at increasing cost as they order more and more procedures? Don’t order tests if you are not acting on the results. Have frank discussions about end of life issues and aggressively use hospice care in the appropriate setting. These are not “death squads.” This is just good patient care. Twenty-five percent of all healthcare dollars are spent in the last six months of a patient’s life. This has to stop.

    I also am quite cynical about the MIPS payment system. The point total for reimbursement will be heavily weighted toward controlling costs but patients aren’t being penalized for bad choices. They will still be able to go to any hospital or any ED whenever they chose to do so.

    We as physicians will be the losers in this system being negatively reimbursed for poor patient decisions. The rest of the point system we can manage without difficulty. Reimbursement should be giving incentives to physician practices for good care. Aren’t decreasing hospital admissions by 80% enough to prove you are practicing cost-effective medicine?

    I concur completely about asking physicians how to design the system. Don’t go to big insurance entities, big pharma and big hospital systems to redesign the systems. It is the physicians and their ancillary personnel who understand how the system should work. 

    Build the system around a strong primary care workforce. This has been proven over and over again in other parts of the world. Cut out the special interest groups and lobbyists in the federal government and do what is right for a change. This may be the last time we have an opportunity to do this in a long while.


    Ed Bujold, MD, FAAFP

    Granite Falls, North Carolina



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