Revitalizing Primary Care, Part 2: Hopes for the Future

Thomas Bodenheimer

doi:10.1370/afm.2859

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RE: Dr Bodenheimer's reflections
JEAN M ANTONUCCI

Published on: 19 October 2022

Published on: (19 October 2022)
Page navigation anchor for RE: Dr Bodenheimer's reflections
RE: Dr Bodenheimer's reflections
JEAN M ANTONUCCI, Physician, Jean Antonucci MD indepednet contractor
Sadly, Dr B is wrong. Panel size, payment and teams will not fix primary care.
We need functional unified EMRs, and changes in policy and in the culture that are unlikely.
Dr B wasn't wrong when he co-wrote Improving Primary Care. In that book was the case of a woman with breast cancer who was referred out and hopelessly lost in the system. My first EMR would have tracked her so I could follow up. My current EMR sends patients to a faraway “access center "where some MA finds patients some place to be seen, and care coordination is impossible. My first EMR did not meet MU -what is the message we send to PCPs? We need one EMR that has basic functional features.

It is not money, it is how hard it is to get it. Coding for billing games, clearing houses and scrubbing, begging to be paid, costing us thousands of dollars.
RI did get more money but little trickled down to primary care, most lost in administrative bloat. The sparkling gems of RI micropractices with their small panel size and house calls to new mothers are all gone but for one who does MAT.
What is wrong and is unlikely to be fixed is our culture with our legislators and their lobbyist bedmates, as well as hospital behavior-one cannot order a test unless it is inserted in their system -which one is not allowed to access; insurers’ policies forcing PCPs to stop work, reduce access and write the referrals f or XRT that were made by surgeons for that woman with breast cancer- s...
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Sadly, Dr B is wrong. Panel size, payment and teams will not fix primary care.
We need functional unified EMRs, and changes in policy and in the culture that are unlikely.
Dr B wasn't wrong when he co-wrote Improving Primary Care. In that book was the case of a woman with breast cancer who was referred out and hopelessly lost in the system. My first EMR would have tracked her so I could follow up. My current EMR sends patients to a faraway “access center "where some MA finds patients some place to be seen, and care coordination is impossible. My first EMR did not meet MU -what is the message we send to PCPs? We need one EMR that has basic functional features.

It is not money, it is how hard it is to get it. Coding for billing games, clearing houses and scrubbing, begging to be paid, costing us thousands of dollars.
RI did get more money but little trickled down to primary care, most lost in administrative bloat. The sparkling gems of RI micropractices with their small panel size and house calls to new mothers are all gone but for one who does MAT.
What is wrong and is unlikely to be fixed is our culture with our legislators and their lobbyist bedmates, as well as hospital behavior-one cannot order a test unless it is inserted in their system -which one is not allowed to access; insurers’ policies forcing PCPs to stop work, reduce access and write the referrals f or XRT that were made by surgeons for that woman with breast cancer- so that PCPs in actuality get XRT paid. No one even talks about this humiliation. There have been lots of home run practices but most get beaten up by policies, insurers, consultant behavior and a culture that loves to say it loves primary care but really wants an MRI for every headache.

It isn’t panel size, Dr B, it is the ability to serve the panel. Our souls are crushed out here.

Additionally, employment has blinded and silenced any physician who might have once known what was going on. I ran a gem of a practice for 15 yrs. And now work one day a week in a system with very caring teams but complete lack of access, continuity or comprehensive care. Where the administration refuses to fix access because it might hurt the ER -but OK if we hurt. Run for President, Dr B, and those of us out here who have hands on run a practice will tell you that we need vaccines in unit doses, to stop having to write referrals to ophthalmology and radiation oncology. Not one of our professional organizations is working on helping us. We could unionize and speak up as docs but,sadly, we won’ t. Primary care in this country has been being crushed since before I entered it.
Panel size and payment will not solve the problem .What was a bright girl like me doing wasting her brain?
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Competing Interests: None declared.