05 September 2013

PCPs Are Putting Themselves In a Bad Light

Primary care physicians are taking it on the chin, but in many cases are doing this to themselves. I think doctor bashing is too polite for the things I am reading about what the PCPs are doing. Dr. Michael Cetta cites even more cases where PCPs are damaging their profession. In some areas of the US the shortage is already being felt and people are reacting negatively to what they are doing.

I am even hearing about court actions against some PCPs for not doing what they are not letting others do. Yes, this is getting very upsetting in some areas. These doctors have smashed the pedestal they had placed themselves on, and people are hauling away the pieces. When primary care isn't available like the example covered in this blog, tempers become very short. I have heard from the fellow in this blog again and the doctors are dumping all patients working for the company because they could not wait for about six months for an insurance required physical. If the company was requiring the physical, then they should have waited, but the insurance company would give no extra time. The fellow said this is getting very nasty in the community. Two doctors that had insurance are without insurance because a division of the insurance company that required the physicals, canceled their insurance.

Since this is a company town, this meant that 90% of their patients were gone and the remaining patients said no thank you and are looking elsewhere for a doctor. Then the owner of the building containing the offices of the two doctors served them with an eviction notice because he said they would not be able to pay the rent. One has already moved into another office about an hour away and the second will be joining him. What surprises this person is that the doctors are trying to prevent other doctors from moving into the town they were evicted from.

In some larger communities, Transition Care programs are beginning to take up the slack for PCPs to care for patients fresh out of hospitals. Because of the emphasis by the Centers for Medicare and Medicaid Services (CMS) of penalizing hospitals for too many readmissions, Transition Care programs are sending healthcare providers into the patient's homes. This is stirring up opposition from PCPs who don't want another care provider stepping in, or the PCPs don't understand the value. After all, (tongue-in-cheek) aren't PCPs supposed to have a proprietary right to oversee their patients' health.

The telling fact is disturbing because everyone does not have a PCP and about 50 percent of the Medicare readmission patients will not have been seen by a primary care physician between admissions. Of the $17 billion spent each year on only Medicare patients, 75 percent of those readmissions are considered preventable. Why aren't the PCPs taking care of them? Because they do not have office time to fit them in and some patients do not have access to a PCP.

Dr. Cetta has this example, “To solve this enormous problem, Transition Care programs need to work closely with PCPs. But right now, a large number of patients who could benefit most from Transition Care are weeded out of the programs because of PCP opposition. In one recent pilot program at a hospital in Maryland, roughly a third of all patients who otherwise qualified for Transition Care were weeded out because of their primary care doctor’s opposition.”

Turf wars are not pleasant for the patients and it is time to have patients take up the cry to PCPs saying if you don't have time to see me, then step aside, you will no longer be my doctor. Even caregivers are considering this, as they don't wish to see their people reenter the hospital so soon after discharge.

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