Addressing Primary Care Need in the Face of Healthcare Reform

Shortages of primary care physicians are becoming more and more commonplace and medical schools produce fewer and fewer residents with a primary care specialty. Driven by a lack of compensation for their services, primary care physicians compose only 31% of today’s physician complement, while only 25% of current medical school residents are training in primary care. Looking out ten years, it is hard to envision the primary care physician supply in the U.S. meeting the population’s needs.

This will be exacerbated by healthcare reform, which will create even more demand for primary care. Thirty-two million more individuals will have insurance and some proportion of that will seek out primary care services.  And new care models, such as Accountable Care Organizations and Medical Homes, seek to expand the role of PCPs in care coordination.

How will hospitals that are already lacking in primary care supply meet these new challenges? Healthcare Strategy Group recommends developing a primary care strategy, and address the following six tactics to ensure your system and community have the primary care resources needed.

Focus on Physician Recruitment
Whether recruiting new primary care physicians to private practice or adding them to your employed network, building your supply will be crucial. Employed networks need a strong primary care base to drive referrals through the system, and as the supply of unaffiliated primary care physicians dwindles, it will be critically important to make sure your network has a strong primary care base that can support your specialists and hospital.

Designing the right recruitment package, model, and compensation plan to retain these providers and keep them aligned with your system will be of utmost importance. See the accompanying article on recruitment for some pointers on that topic.

Integrate Mid-Level Providers  
Mid-level providers, such as Nurse Practitioners and Physician Assistants, will be important to supplementing the gaps in physician supply that your community will face. Faced with this reality, many states are augmenting current legislation to allow for expanded duties for mid-level providers. Developing an approach to incorporate these extenders in a way that fits with the culture of your medical community will be a core element of successfully responding to the demands of reform.

Manage the Throughput Process
Most could improve their throughput of patients. Fixing and streamlining cumbersome office processes should be an area of focus. Optimized scheduling, and controlled overbooking is one such factor. Creating staff incentives to facilitate aggressive scheduling is likewise a key to success.

The MGMA Cost Survey has some surprising findings relevant to this issue. Hospital owned practices have less support staff per physician than do independent physicians. This focus on reducing FTEs may lead to long-term throughput problems. It is important to recognize that high-volume practices require more staffing resources to accommodate the increased patient load.

Referral Management
As you build the primary care network that will carry you forward, build from the start the mechanisms to control referrals. Many hospitals tread on this lightly, which may be the politically correct approach. But failure to manage this issue will guarantee that the true value of the group will not be achieved.

Focus Your Marketing
As you build a primary care group to be a powerhouse in the market, you need to do so with an eye on developing a core marketing strategy. You need to define the desired positioning and the accompanying marketing message, and incorporate that into any promotional efforts. Direct marketing efforts to desired patient populations. Practice locations must be strategically selected, in order to maximize their value. Finally, the practices’ operations must be structured in order to ensure that patients have a great experience, and return to the practice in the future, rather than to a competitor.

Culture Development
Bundled pricing, ACOs, and Medical Home models will require primary care physicians to change their focus and mode of operation. This will not be a small change, as they have largely been trained to care for sick people, not manage the health and costs for a population. You need to develop a physician leadership group who understands this objective and can help you transition to that model and mindset. This is, in essence, an effort to mold the group’s culture to maximize their value as the market evolves and purchaser requirements change.

Conclusion
Meeting the needs of a much larger insured population, which will drive higher utilization of primary care physicians, will be challenging. Getting your PCPs to focus on managing care, when they are potentially facing a tidal wave of patients, will be a bigger challenge. By developing your primary care network now and systematically addressing the six issues above, your ability to meet the primary care demand of your patient population will be strengthened.