It’s The Access, Stupid!

Or is it the availability?

An opinion piece in the AZ Daily Star about access to primary healthcare prompts this reply. The author praised the HC system in the Netherlands for providing better access because of their use of electronic health records, and, more importantly, for coverage arrangements for PCPs when they were out of office.

We could provide better PCP availability (more people who have ‘their own’ doctor) as well as accessibility (“We can see you at 10 today, Mrs Jones.”) by making a few simple corrections in the current system with or without EHR. This would be under the category of “True Reform”; we consider current congressional efforts to be, using a word from Click and Clack, bogus.

Step One. Discourage current PCP practice of cramming an office day completely full and then some, just to make ends meet. Do this by changing the method(s) of compensation from fee for service to some other payment schedule related to performance and patient satisfaction. This might be a base salary plus incentives for features just noted.

Step Two. Encourage PCPs to work at their skill level, and to delegate routine, simple office matters to lower skilled personnel (NPs, Pas, even medical assistants).

Step Two B. Educate patients out of their dependence on formal medical care for colds and other self-limited conditions.

Step Three. Utilize email and other electronic methods to communicate with patients; consider “virtual” office encounters for shut-ins.

Step Four. Provide adequate financial incentives to encourage PCPs to work together in providing extended coverage in an area / town / city; this might be a schedule of office hours which varied among doctors to provide an open PCP office 7 days a week from 7AM to 7PM. Adapt to local conditions and resources.

Step Five. Install an EHR system available to all participating physicians to insure access to current patient information during coverage situations.

Taking these steps should resolve problems associated with availability, and access to care. An added bonus would be improved quality of care, since a physician in this system, freed from obvious financial concerns as well as the burden of “seeing” huge numbers of patients, can devote more time to complicated cases.

When considering reform, possession of healthcare insurance (varying according to patient needs and wishes) should be a separate issue.