Page 37 - Delaware Medical Journal - May/June 2018
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Addressing the Primary Care Crisis — Senate Bill 199
Richard W. Henderson, MD
On Wednesday May 9, nearly 20 primary care physicians and others who provide primary care
services, dressed in suits and white coats,
the Senate Hearing Room in Dover to delivery an urgent warning: primary care is failing in Delaware.
It was a call to action. For almost an hour and a half, they shared with senators what our friends and neighbors have been rumbling about for more than a decade: Delawareans cannot get access to basic primary care.
Patients are forced to move from practice to practice. Many of those practices aren’t taking new patients. Wait times are long and visits are short. Community practices are closing, joining hospital systems, or adopting alternative models that require patients to make additional payments on top of insurance in order to keep their doors open.
This swing away from traditional, available primary care practice has resulted in some of the worst access in the nation for some of our most vulnerable, like the elderly and our children.
Delaware has fewer primary care physicians per capita than any surrounding state. Kent County, Sussex County, and parts of New Castle County are designated by the federal government as Health Professional Shortage Areas. New physicians, nurses, and PAs aren’t Delaware. Health care costs continue to
climb and Delawareans’ health continues to struggle.
Between Medicaid expansion and the Affordable Care Act, more patients have insurance. A wave of retirees has brought a larger Medicare population to Delaware. If there are so many more insured people, why are practices failing?
A major source of the problem is the fact that independent primary care physicians are reimbursed at a much lower rate in Delaware than in other states. Around the country, commercial insurers pay primary care 20-30 percent above Medicare rates. In Delaware, commercial insurers pay independent primary care physicians 15- 35 percent below Medicare rates, and even
— unheard of in other states. This is not sustainable for a primary care practice.
Delaware has not invested its health care dollars in primary care. Published studies agree that a robust health care system should spend at least 12 percent of total costs on primary care. In the U.S., the average is 5-8 percent. In Delaware, it is 3-4 percent!
It is estimated that every dollar invested in primary care saves the system between $2 and $15. In other states, where money has been invested, the cost curve has bent and the population has become healthier. Rhode Island dropped its costs of care
by 18 percent after a mandated primary care investment. Oregon returned nearly $15 for each dollar it invested in primary care. Colorado is working on legislation that will require a 15 percent primary care investment.
Health care coordination through a robust primary care system helps patients with complicated and chronic conditions navigate a confusing health care system. It has been estimated that one primary care physician per 10,000 people can decrease hospital admissions by 5 percent, visits to the emergency department by 11 percent
and surgeries by 7 percent. Through primary care coordination, it has also been estimated that approximately $210 billion per year nationally may be saved on unnecessary or duplicative tests. When evidence-based, preventive health care
is provided in the primary care setting, researchers estimate savings as much
as $3.7 billion may also be achieved in
the U.S. These are numbers that cannot
be ignored or dismissed. Medicare has recognized its value, but commercial insurance in Delaware only pays one tenth of what is necessary to provide these invaluable and proven services.
What can be done? Senator Bryan Townsend and Representative David Bentz, the health committee chairs of their respective chambers, have taken action. They’ve introduced legislation: Senate Bill 199.
This legislation has two fundamental and deeply necessary components:
First, this legislation level-sets by creating
Medicare. This stopgap measure will save some of Delaware’s dwindling practices currently on the precipice.
Second, in the long term, this legislation requires that insurers move 1 percent of their total spend per year into primary care, to
12 percent by 2025, to grow our access to in how those dollars are spent to ensure that the robust discussions around health care delivery transformation are implemented.
There’s time to save primary care, but the time for talk has ended. Please, urge and support passage of this legislation.
CONTRIBUTING AUTHOR
■ RICHARD W. HENDERSON, MD is a practicing Obstetrician and Gynecologist with St. Francis Hospital in Wilmington and is the President of the Medical Society of Delaware.
OPINION
Del Med J | May/June 2018 | Vol. 90 |
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