This commentary is by Michael Johnson, M.D., managing partner of Evergreen Family Health, based in Williston.
I am the managing partner for one of Vermont’s largest independent primary care offices. For the last year, I have been working with a dedicated team from Blue Cross Blue Shield to implement sensible patient-centered quality measures.
However, the premise that Vermont’s health care crisis can be fixed by focusing on value-based reform or improving the quality of care is insulting to Vermont’s primary care practitioners and not based on evidence.
Vermont needs more, not less, primary care. Data shows that primary care offices in Vermont have been providing above average care for many years. There is no primary-care quality or value crisis in Vermont. Vermont has an affordability crisis and an access-to-care crisis.
Vermonters end up in emergency rooms, urgent care centers or hospitalized because of the lack of available appointments with their primary care office or outpatient specialists. The last 10 years of value-based reforms have worsened the actual problems of affordability and access while trying to improve the already high quality of care.
Paying primary care offices differently will not attract more primary care practitioners, nurses or staff to the state or keep primary care staff from leaving. The only way to reverse the primary care exodus is by rectifying the years of underfunding.
Health systems save money when people can more easily see their primary care practitioner. Any program incentivizing primary care documentation, rather than primary care access, is doomed to worsen our actual problem.
The goal of health care reform in Vermont must be revitalizing affordable, accessible primary care. Value-based reform efforts thus far have resulted in a shift from office-based primary care to hospital- based care, from the least expensive offices to the most expensive models.
The last 10 years of reforms have led to more independent primary care offices closing their doors. With some of the highest health- care costs per capita in the world, Vermont doesn’t have a funding crisis; we have a misfunding crisis.
Rather than more studies and costly administration, we simply need to stop expecting primary care to do more with less. If primary care reimbursements had merely kept up with overall health care inflation, we would not be in this crisis.
Vermont needs to require public and commercial payers to adequately reimburse primary care without increasing a costly administrative burden.
