The Unbearable Irrelevance of Primary Care

Given the tremendous interest in this post, we thought we’d move it back up to the top for a re-read.

It’s quite a paradox.  Read any recent healthcare article, blog, or post; the pages and posts are resplendent with detailed descriptions of new payment methods, organizational structures, and realignments.  They all extoll the central role of primary care in the high quality cost effective  healthcare system of the future.

And yet … in Washington state, the primary care crisis is accelerating.  As I type this, the Health Care Authority is pursuing a path to recoup retroactive Medicaid payment cuts from primary care physicians across most of the state.  And its not just a few dollars; the takebacks in many cases are greater than 50% of a rural primary care physician’s annual salary.

Can you imagine this happening in your line of business?

Customer:  “I know we paid you in 2009 for that clinical visit – great job, by the way – but now we need more than half of the payment back.”

You:  “But I already paid taxes on that, and invested the revenue to better coordinate the care I provided you in 2010, 2011, and today.”

Customer:  “Again, really great job.  Thanks for that.  Smart of you.  But, we need it back.  Regarding 2010 and after, we’ll be in touch soon to collect those payments, too.  But, don’t blame us – the feds are making us do it.”

Primary care doctors don’t need to be “spurred”, pushed, or otherwise convinced to improve their practices.  Many have been pushing forward, even within the current payment system.  In our practice, we’ve added early morning and evening office hours, created ER diversion programs in partnership with our hospital, and hired additional providers to make sure we always have enough same day appointments to meet our patients’ needs.  The right care, in the right place, at the right time.

Faced with another round of payment cuts and repayment liabilities, we will now dismantle those improvements. We’ll cut back our hours and providers to the number of appointment slots we are guaranteed to fill 100% of the time.  Our remaining physicians will try to see at least 2 more patients per day.  We’ll send our overflow patients to the ER.

It’s great to hear our primary care clinics will be the center of the new healthcare universe.  What if none of us are left by the time we get there?

Cindy Roberston is the Administrator for NorthShore Medical Group located in Stevenson and White Salmon.  She is a board member of the Rural Health Clinic Association of Washington.  Her email is