Reducing Administrative Burden

This post originally appeared on MedCityNews March 30th through its Influencers program. 

Primary care has demonstrated remarkable resilience in spite of the intense pressures of the pandemic, and there is critical work to do to help our nation recover from the wide-ranging consequences of Covid-19.

The common story about the impact of the Covid-19 pandemic on the healthcare sector is that of emergency rooms and hospitals, which remain overwhelmed and understaffed. Health providers in these care settings have been traumatized by wave after wave of patients—many whose lives often could not be saved, despite the best medicines and most heroic interventions money can buy. Nestled deeper within the pandemic narrative is the story of primary care physicians who have been fighting on the front lines of the same war but face different battles.

More primary care physicians have been lost to Covid-19 than any other medical specialty. PCPs have struggled to meet the new demands of virtual care delivery, long-Covid syndromes, vaccine hesitancy, science denial, patient anxiety, financial strain, overflow from crowded ERs and many other challenges.

In spite of these intense pressures, primary care has demonstrated remarkable resilience, striving always to steadfastly serve our communities—many which have been hard-hit by financial crises of their own. As a practicing primary care physician, I want to help readers understand what’s ahead this year for primary care, a discipline unlike any other specialty in medicine, and why primary care needs to be leading the charge in 2022.

The pandemic was a forcing function that caused an explosion in telemedicine. In my own practice, I now have patients whom I’ve never even met in person, yet we have a strong therapeutic relationship: the foundation of high-quality primary care.

An entirely new sector of the industry is booming—built on telehealth platforms—and technology has flexed to keep up. That includes rushing at the very start of the pandemic to deploy a HIPAA-compliant, integrated telehealth solution powered by Zoom. For primary care, this new “channel” of patient communication has become a fundamental component of the care delivery system. It reduces overhead, expands access and is incredibly convenient for the patient, who no longer needs to take time off work, find a sitter, fight traffic or sit in a waiting room with other patients who are potentially contagious.

Indeed, virtual primary care, as a new component of a comprehensive primary care practice (and not to be conflated with virtual urgent care), is one of those things we can’t take back. It’s here to stay, and our reimbursement policy will need to reflect its value, considering its impact on patient experience, access to care and total healthcare costs.

If the past few years are any indication, we can also expect 2022 to bring more innovation in healthcare payment models focused on “value” as defined by better health outcomes at a lower per capita cost. Primary care is the only medical specialty for which more is better. Following this premise, alternative payment models intended to increase value often involve changes to how (and for what) primary care is paid.

One new payment model innovation for 2022 is the Centers for Medicare and Medicaid Services’ Direct Contracting Entity (DCE) program. This essentially duplicates the Medicare Advantage model with traditional Medicare beneficiaries in contracting with private, for-profit companies who agree to manage the total cost of care for a defined population, assuming both upside and downside risk.

Within these contracts, the DCE has complete flexibility to determine how PCPs are paid—capitation, pay for performance, shared savings—all options are on the table. Whether this program will have similar results as Medicare Advantage programs (increased costs to CMS, with minimal or no improvement to health outcomes), or might benefit from private sector hacks, will be closely watched.

Another development to keep an eye on in 2022 is the rapidly accelerating expansion of the Direct Primary Care (DPC) model. In the DPC model, primary care doctors have completely opted out of the insurance billing and reimbursement headaches and instead are putting patients in control of the money. Patients pay a monthly or yearly subscription fee to the practice in exchange for longer appointments, unlimited and enhanced access to their PCP, and most clinic-provided services and procedures covered under this single fee.

Previously considered to be affordable only for the wealthy, patients, physicians and employers are finding new and creative ways to fund this model so that it doesn’t add to a patient’s out-of-pocket expense. What has been lacking is outcomes reporting on the DPC model to validate that this approach indeed creates more value for patients and the healthcare system.

Technology to support healthcare has become a very big business. The challenge lies in the physician’s user experience, where a cacophony of systems, platforms, and log on credentials carry the potential for fragmentation of patient information, unnecessarily complex workflows and increased overhead.

In 2022, I’ll be looking to professional organizations like the American Academy of Family Physicians to help define the optimal digital ecosystem for family medicine (and, by extension, other primary care specialties). Interoperability to achieve a seamless user experience will be the cornerstone of such efforts, along with comprehensive data integration to create a “whole-person” clinical picture, reduction of documentation burden (without compromising quality of information), smart population management tools with predictive analytics, and low-hassle reimbursement support that maximizes revenue to the practice.

Primary care doctors have critical work to do to help our nation recover from the many sequelae related to this devastating pandemic. Stress-related illnesses, occult mental health symptoms, long-Covid syndromes, and a variety of other health consequences will be making their way into the caring hands of a primary care physician for years to come. My hope is that government, the healthcare system, and industry will collaborate to empower primary care doctors to serve their communities in the ways that only they can, supported by the right technologies, policies and payment models to do this crucial job well.