July 28, 2011

Of mystery shoppers, country doctors, and a meeting with Bill Clinton

Last month, the federal government disclosed—then quickly abandoned—a plan to unleash “mystery shoppers” on 4,000 primary care practices across the United States. The goal? To see just how many providers refuse to take new Medicare and Medicaid patients.

The government dropped the plan after some professional groups cried foul. Although our country needs reliable information about access to primary care—especially for those on Medicare—reluctance to face hard facts prevailed. Why? Providers get more favorable reimbursement for privately insured patients than for those on Medicare on Medicaid. Mystery shopping might have revealed what federal surveys so far have not: Major problems with access. But the episode did highlight challenges our country faces in creating, and paying for, a more humane health care system.

I believe most Americans know what they want. Dr. David Loxtercamp articulated it a few weeks ago when he talked with Liane Hansen on NPR. A family physician and medical home advocate in Maine, he wrote the 1997 book, A Measure of My Days: The Journal of the Country Doctor. He told Hansen how the current predominant model of primary care is broken and American medicine is “on the verge of a great sea change.” He also outlined a new way: the patient-centered medical home, which addresses problems of access, communication, and care coordination, while holding fast to the primacy of the patient–provider relationship.

Dr. Loxtercamp shared 14 “Hippocratic aphorisms” he uses to define good care, including:

  • “Health is not a commodity.”
  • “Risk factors are not disease.”
  • “Patients cannot see outside their pain, we cannot see in. Relationship is the only bridge between.”
  • “The most common condition we treat is unhappiness. And the greatest obstacle to treating a patient’s unhappiness is our own.”
  • “The foundation of medicine is friendship, conversation, and hope.”

Hearing this, I thought about Group Health’s evaluation of our own patient-centered medical home. Many of our providers reported that the model helped “revitalize” their commitment to primary care. By shifting the ways team members interact with their patients and with each other, they could give their patients the more meaningful attention needed for effective treatment and healing. Several providers who had been thinking of leaving primary care or taking early retirement changed their minds. Instead, they decided to stay and do the important work that had attracted them to medicine in the first place.

Group Health’s Dr. Rob Reid had the chance to talk about the revitalization of primary care at an extraordinary meeting in Chicago last week. Hosted by President Bill Clinton and his nonprofit Clinton Global Initiative, "CGI America" focused on spurring U.S. economic recovery and job growth. One main theme was the current mismatch between the skills needed for economic recovery and the number of people who have those skills. Health care has a shortage of people trained in the new skills needed to meet the needs of an aging population with complex chronic health problems. Meeting organizers asked participants to bring their organization’s workforce development commitments to the table: solid, practical plans to help build a workforce that can better promote a stronger economy.

Rob is Group Health’s associate medical director for research and knowledge translation and a Group Health Research Institute (GHRI) associate investigator who leads our medical home evaluation. He described Group Health’s commitment to developing and training a new primary care workforce that supports more team- and population-based primary care—and that jibes with the basic principles of primary care, which Dr. Loxtercamp’s Hippocratic aphorisms express so well.

The headline on the Newsweek cover story about Bill Clinton’s summit harkened back to a line from his 1992 presidential run: “It’s still about the economy, stupid.”

In health care, it’s always been about the patient–provider relationship. And despite the sea change we’re experiencing, it still is.

Hear Dr. David Loxtercamp tell Liane Hansen his 14 Hippocratic aphorisms on NPR.

Read the New York Times on the abandoned federal plan for primary care “mystery shoppers.”

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