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by Rose Rohloff The June 29, 2018 BECKER'S Hospital Review article shares the viewpoint "Froedtert CEO Cathy Jacobson: Not every patient needs a primary care physician" (PCP). The article is the perspective from the viewpoint of a health system CEO. The following is a perspective, counterview from patients, the individuals in the population.  In speaking with individuals across the country, spanning several major health systems and states, 100% of the comments and feelings are that health systems are large, top-heavy and more inefficiently run because of their size. Many people have expressed utter frustration from lack of a good Primary Care Doctor, warranting unnecessary ER visits because a doctor will not call back; the lack of one doctor in charge who would simply LISTEN to them, who knows them - not as personal friends, but with an in-depth professional relationship. I have been asked several times in various states, "Do you know of any good Primary Care Doctors? I cannot find one." Universally, I am hearing about the lack of comprehensive assessments, getting to know and listen to what is going on, causing the passing through of patients to specialists versus a primary care doctor creating a plan of care and focused tests for getting an actual diagnosis; along with hospital visits with increasing costs that could and should be avoided because of the conditions getting worse or prolonged because the doctor does not take the time to get to know the patient and their symptoms. Health systems are relying on data analysis, defining as population health, as Froedtert is quoted, "As we start stratifying our patients into distinct populations based on their health needs." The issue with this premise is that the data is not always clean, and it will never tell the story, the whole story, of the realities going on with the patients. (See I Wish I Had Known stories.) Her quote continues, "... insight further into consumer driven wants, we are finding that a substantial sector of the population does not want or need a primary care physician relationship. People need primary care but not necessarily a physician relationship." The issue is the primary care physician practices have been acquired by the hospitals with the biggest complaint from people, of not being able to find a PCP, and those now under health systems, the doctor only giving 15 minutes of time and then passing off with no plan of care, simply writing another prescription. Many in the public just find it faster or are being told to just go to the ER. From the perspective of health system CEOs, it would appear primary care is not wanted or needed. But when actually speaking with individuals across the country, it is the opposite from the lack of care coordination, and "the doctor doesn't know me and is not taking the time to listen to figure out an actual diagnosis." 
19 Comments
No surprise here.
Philip H. Greger Jr. MD MBA FACS
7/16/2018 04:33:16 pm
Because to the hospital CEO, that is the driver of healthcare costs. In reality all "they" need to do is look into any mirror to see the true culprit behind the costs.
Robert Nelson, MD
7/16/2018 04:35:42 pm
Although I agree with Dr. Greger about core cost-drivers, I'll be a little more benevolent and say that it is the system acting in concert which moves the aggregate in the wrong direction. I don't believe there are a lot of true villains really (just bad incentives) but certainly some of those that know the system is broken and continue to advocate for more of the same. Those take advantage of the situation. There are also many well-intentioned healthcare workers on both the clinical and administrative side that are just blindly responding to the current that sweeps them along and playing by the rules of the game that they've been given. They just don't look deeply enough to figure out the dysfunction although most people know innately but there's something wrong. 7/16/2018 10:02:41 am
Having a professional relationship with a PCP is the biggest component of the very definition of patient engagement. The question to ask, Why would a CEO advocate against it? 7/16/2018 10:04:28 am
Interesting dichotomy. In some ways the CEO who is quoted has rigged the outcome such that she is justified, in a weird kind of way, to claim not all patients need a PCP. 7/16/2018 11:54:40 am
I'm speechless--and have no explanation!
Rose Rohloff, HC Aware
7/16/2018 12:09:08 pm
From the article: "CJ: Individual hospitals, but more so large healthcare systems, are held together financially by a very complex system that relies on pieces and parts to make the whole work. Whether it is certain service lines that are more profitable than others, balancing payer mix or utilizing Medicare reimbursement mechanisms to maximize revenue ..."
Richard Belloff, DBA, FACHE, PAHM
7/16/2018 02:48:33 pm
That is so spot on, it hurts. Well done, Rose.
Robert Nelson, MD Spokesperson - Georgia Chapter of the Free Market Medical
7/16/2018 03:13:23 pm
I found the interview and the answers to the questions to be less than inspiring. The current model does need to be disaggregated in my opinion. The idea of these conglomerates that try to be everything to everyone 24/7 as really sustainable is a myth that should die; I don't believe the current model really jives with the way we look at Healthcare and would utilize it, if we were given opportunities to desegregate the Giant. This model has bankrupted the middle class and is chock-full of disincentives, perverse incentives and distortions to over utilize and over test and over treat and to distort and inflate cost because of the absence of prices that should be much easier to determine in 80 to 90% of our excursions into the healthcare arena.
Robert Nelson, MD
7/16/2018 03:19:29 pm
Here is quote from CJ which I believe tells where she stands on this issue on many levels. Although she talks about consumer engagement she makes it very clear that she wants to maintain the hospital-centric view of healthcare and all the Unholy Financial mechanisms that support it. Here is the quote:
Philip H. Greger Jr. MD MBA FACS
7/16/2018 04:28:42 pm
Robert: Right on! It kills me to hear from someone that spent 30 years in the business to now say, "We all want to reduce costs and create a more consumer driven experience, but we have to preserve a way to keep the system there for when it is needed." What the hell have they been doing for the last 10 years under the ACA? This is what they were charged with. Instead, they took a different tact and made obscene amounts of money by buying up physician practices with guarantees under the ACA (pushed by the AHA) that hospital reimbursement would not be reduced and could be increased (and was) from 2010 to 2018, even under a revenue neutral financial system. Oh, and I left out the record breaking M&A activity that hadn't been seen since the 80's. Coming from an MBA, it's hard to even write "obscene amounts of money," but I did it anyway.
Robert Nelson, MD
7/17/2018 09:17:18 am
This CEO says she wants to support & respond to consumerism.. just as long as she gets to control the choices which are made available! She shows a poor understanding and/or disregard for patient-consumers exerting their will & voting with their dollars in a REAL free market!
Robert Nelson, MD
7/16/2018 04:38:29 pm
to: Philip H. Greger Jr. MD MBA FACS 7/16/2018 07:26:54 pm
Exactly. Thank you for posting. And this lack of a PCP relationship is driving up the cost of care downstream.
Albert Lopez D.O. FASPC Physician/CEO Real Life Health
7/17/2018 09:01:38 am
Primary care physicians: overloaded, dumped on by specialists, underrated, taxed, underpaid. 15 minutes per patient in this world it is 10 to 7 minutes per patient, Since we are paid on a volume basis, if you spend time with the patient the patient will tell you what’s going on if you listen.
Richard Belloff, DBA, FACHE, PAHM
7/17/2018 09:06:05 am
My doc is part of a 4-person, private group. He lives in a very different world than the one you describe. Then again, his group has refused to sell itself to the big hospital system, which has been trying to buy the group for about 25 yrs. 7/17/2018 09:08:26 am
What I am hearing across the board from physicians as well, "I got into medicine to help people." It is the top heavy admin, wasted paperwork, inefficient and inaccurate reporting, with the push for assembly-line volumes to support the organization operating margin. Robert Nelson, MD pointed out from the article the focus on sustaining the organization, "The parts that keep the whole afloat are in danger of being picked off, which threatens the overall system. We all want to reduce costs and create a more consumer driven experience, but we have to preserve a way to keep the system there for when it is needed."
Robert Bowman, Basic Health Access, Phoenix, AZ
7/17/2018 09:13:34 am
As a Reminder, this Quote from Jim Purcell was directed by him to fellow CEOs, physicians, and execs in health systems and insurance: “Permit me to share a truth with you. OFFICE VISITS NEVER BREAK THE BANK! Never. It’s the lack of office visits which exacerbate already existing chronic situations that result in in patient hospitalizations and specialist involvement over extended periods that break the bank. The other item that breaks the bank is the leveraged whammy of untreated combined psychological and physical health maladies which are the single biggest driver of fee for service Medicaid expenditures today. Again, office visits never break the bank.” Jim Purcell in The Health Care Blog Some would argue that with FFS primary care, we’re already in a situation where people don’t have true primary care. It’s more like referral care designed to speed you to expensive health system services. A health system CEO is one of the last places I’d go to understand the future of healthcare. No different than why I wouldn’t have gone to Kmart or Sears to understand the future of retail/commerce back in the late 90’s. Looks obvious now but people are doing the equivalent of asking Kmart about the future of retail right now. Leave a Reply. |
