With healthcare reform comes need for new primary care system

Dr. Randy Martin: The reality is that it is hard to find a primary care doctor these days who will take care of you, accept your insurance or lack of insurance, and has the time to see you. From the patient perspective, it is very complex. I met with Dr. Jim Sams, the medical director of Piedmont Physicians Group, to learn more about how healthcare reform is impacting primary care physicians and patients, as well as an innovative new model that will improve patient care.

“At this point in time, primary care physicians are at a shortage and a premium,” says Jim Sams, M.D., medical director of Piedmont Physicians Group, the employed primary care physicians at Piedmont Healthcare. “The structure we are required to work under – because of the economy – requires high volumes [of patients] from the primary care perspective to make it work.

“[The current model] is fee-for-service,” he says. “It creates barriers to care, and problems with compliance and [patient] health.”

Baby boomers will soon turn 65 and previously uninsured patients will become insured under healthcare reform laws, leading primary care doctors to care for an unprecedented volume of patients.

“The existing system cannot handle this [demand for primary care] in any way, shape or fashion,” he says. “We have a very short window to address the supply and demand side of how we care for patients.”

What is the solution to the boom in primary care demand?

“We have to find a way to build teams to accomplish this,” says Dr. Sams. He explains that, under an innovative healthcare system called the Patient-Centered Medical Home (PCMH), an entire team will be assigned to caring for a patient.

Patient-Centered Medical Home (PCMH)

A PCMH is an innovative way to improve primary care for patients. A team of healthcare providers work together to ensure the patient has access to the resources he or she needs and that care is tracked over time – so patients do not get lost in the shuffle. Compounding the issue of a high volume of patients is the lack of medical students going into the field of primary care, choosing to pursue higher paying specialties instead.

The PCMH seeks to combat this issue by assigning a well-rounded team of experts coordinated to care for the patient as a whole – making sure no one slips through the cracks and that the patient’s health is monitored over time.

“One [primary care physician] cannot handle all components [of patient care],” he says. “We need to build a team of nurse managers, health coaches [and other health professionals] so there is one place where a patient can go to have their care coordinated to make sure it happens in the right way.”

This model also utilizes technology to improve patient care – tracking test results, ensuring prescriptions are filled, monitoring patient care and accessing clinical support. Furthermore, the model has a goal of empowering patients and their families to take charge of their own healthcare.

Dr. Sams says, “Patients can play an active role in their care, ensuring that they get what they need, just as physicians do. This is going to be critical.”

In addition to a change in patient care, an economic shift must occur to bear the load of new patients, says Dr. Sams.

“We are going to have to move from a fee-for-service or fee-for-volume arrangement to a more value-based purchasing system for healthcare,” he says.

Is Dr. Sams optimistic that this shift in healthcare will be good for the patient as well as healthcare providers?

“The financial stakes that are at play here are massive,” he explains. “Healthcare, all by itself, can bankrupt this country by 2050. We have to make it work this time and refocus on the patient and produce the Institute of Medicine’s triple aim: better care, better quality, all at a lower cost. We have no choice but to make this work this time.”

Dr. Randy Martin: As healthcare shifts with changing legislation, the need for a new patient-physician model is more critical than ever. Stay tuned as HealthWatchMD continues to cover this breaking health issue.