The Future of Primary Healthcare

Presented by

Barbara Marx Brocato

Barbara Marx Brocato& Associates18 Pinkney Street

Annapolis, MD 21401Phone: 410-269-1503

Fax: 410-269-5021E-mail: Barbara@bmbassoc.comWeb Site: www.bmbassoc.com

The Health Care Debate

Increased insurance coverage and increased eligibility DOES NOT equal increased access to care

You need an ample provider workforce

Maryland physician workforce is threatened

Governor’s Task Force on Health Care Access

and Reimbursement 2007-2008

Governor’s Task Force on Health Care Access

and Reimbursement 2007-2008 Table 3. Average Income for Selected Specialties in the United States

Annual Income Income Relative to Radiation Oncologist’s Income

Radiation Oncology $489,765 100%

Orthopedic Surgery $476,781 97%

Diagnostic Radiology $449,664 92%

Plastic Surgery $408,065 83%

Dermatology $390,274 80%

Anesthesiology $371,066 76%

Otolaryngology $369,154 75%

General Surgery $330,215 67%

OB/GYN $296,399 61%

Emergency Medicine $258,088 53%

Neurology $254,558 52%

Internal Medicine $191,526 39%

Pediatrics $188,496 38%

Family Practice $178,829 37%

Source: Medical Group Management Association (MGMA). Physician Compensation and Production Survey: 2007 Report, based on 2006 data as published in the New York Times; accessed at http://www.nytimes.com/2008/03/19/fashion/19beauty.html?_r=2&scp=1&sq=the+price+of+beauty&st=nyt; Maryland-specific results are not available due to small cell sizes.

From the December 2008 Report of the Task Force on Health Care Access and Reimbursement Established under Senate Bill 107

Commercial reimbursement in Maryland is in the lowest 25% of the country

Medicare and Medicaid provide very low reimbursement

Maryland is a high cost of living state

Physician recruitment happens in a National market

States with more favorable systems have an advantage over Maryland

The Health Care Environment

Increasingly those “going down the road” to medicine are not going into primary care

Results in a shortage of primary care physicians Leads to increased utilization of

emergency departments and long wait times to be treated

Providers not accepting Medicare Establishing concierge practices – patient

pays an annual or monthly fee for physician to provide services. This is not a substitute for insurance, some concierge practices do not accept insurance.

The Health Care Environment

Health Care Reform Where will the solutions come from(?)

Federal? State? Combination of both?

What are some possible approaches? Fairer provider reimbursement Incentives to attract primary care physicians Loan forgiveness Tort Reform Bundled Payments Medical Homes Case management systems

Barbara Marx Brocato &Associates

For a copy of this presentation

contact us at:

18 Pinkney Street

Annapolis, MD 21401

Phone: 410-269-1503

Fax: 410-269-5021

E-mail: Barbara@bmbassoc.com

Web Site: www.bmbassoc.com