Other Voices: Prescription for looming health-care crisis
Concerns about access to a primary care physician have struck home in Nevada County, reflected in recent letters in The Union. These letters raise many good points and highlight valid issues. Let me elaborate from the perspective of a physician.
In my 31 years of service in this community as a general practice physician, the health-care system in Nevada County has gone through many changes.
Our community has grown and grappled effectively with the health-care needs of our area. The quality of care and breadth of services available to us is remarkable for a rural area. It is a medical community of which I am proud to have been a part.
One of our most pressing challenges now is access to primary care physicians. In recent months, several family-care physicians in our community have closed their practices, resulting in an alarming shortage.
Until now, our community has been able to attract an excellent staff of physicians. But recruiting primary care doctors has become difficult with the current market pressures in California. Medical students are choosing more lucrative specialties or are choosing other professions altogether.
The “evergreen effect” (the belief that the natural beauty of our area will draw physicians) only applies if there is reassurance that incomes offered are a respectful match for the level of service required. Sadly, this no longer appears to be true for primary care physicians.
American citizens realize their health-care system is in trouble on many fronts. A neglected aspect, that of primary care needs, has become apparent. Concerned people are asking for major changes in our health-care system.
Let me touch on a few long- and short-term suggestions.
The long-term solutions relate to a broader overhaul of the whole medical system, starting with Medicare and certainly addressing the large number of uninsured patients. Progressive cuts in Medicare and MediCal reimbursement (MediCal now discounts payment for a complex office visit to $18) and increased costs in complying with federal regulations have provoked reactions in the system that make it difficult for patients to access care.
This issue was highlighted in an article published in the Seattle Post-Intelligencer on March 16 by AP reporter Kevin Freking, titled, “Medicare may hurt access for seniors.” To its credit, however, the federal government has addressed the needs of the underserved through the Federally Qualified Health Clinics (FQHCs)-locally represented by Miner’s Clinic in Nevada City, Sierra Family Medical Clinic in Camptonville, and the Downieville Clinic.
Unlike other providers, these clinics are actually reimbursed by Medicare and Medi-Cal at full fee so their costs are covered and their staff wages paid. Many people in our community worked very hard to overcome the bureaucratic hurdles to make these clinics available and a viable means of access to medical care. They still need your additional support through their foundations.
In the short run, there are some specific things we, as citizens, can do.
Sierra Nevada Memorial Hospital has been in the forefront of developing an internal Electronic Health Record over the past 12 years. Disasters and others health crises have shown the importance of data being available electronically to providers, and how it can open doors to find efficiencies and quality of care improvements.
SNMH, in collaboration with the Sierra Nevada IPA and the Federally Qualified Health Clinics in our community, has made a proposal for federal appropriations funding for fiscal year 2007 and beyond for the creation and implementation of a Community Wide Electronic Health Record.
This has been presented to our legislators for their support. The proposal is complex, but it opens the door for the hospital to provide an electronic network that could extend EHR to all doctors’ offices in our area.
EHR is crucial for communication between doctors for emergency care. It is also an important key to opening the doors to future improved and more competitive reimbursements for physicians. Soon, Medicare will adjust their reimbursement based upon quality indicators through programs broadly called Pay-for-Performance (P4P).
Electronic Health Records will be a necessary tool for physicians to succeed in this new arena of P4P. Our community needs you to tell Sen. Diane Feinstein that we need her support for our Community Wide Electronic Health Record. Kim Parker at the SNMH Foundation call 477-9700 or email firstname.lastname@example.org can assist you with a sample letter for this cause.
In addition, if you are a Medicare patient and you have experienced difficulty with access to a primary care physician, consider whether it is right for you to sign up with Secure Horizons, an HMO form of Medicare. Most area physicians are still accepting new HMO patients and would welcome existing patients to change to HMO plans. I should note that there is a common misperception about managed care through an HMO revealed by the belief that HMO plans prevent the patient from getting the care they need or that the care is second rate.
As a physician, I was able to provide preventive health care and access to urgent services readily through a managed system that was sensitive to patient needs and yet efficient. I was able to obtain access to excellent medical care for my patients through our local network or other contracted providers. The managed care system was actually easier to navigate than other plans like Preferred Provider Organizations (PPOs) that tout wider access. Since our community has a network of excellent physicians available through the HMO, going out of network is rarely necessary or worth the cost.
Through proactive leadership and a medical community unified in the Sierra Nevada IPA (the physicians’ contracting arm), our community has had the good fortune of securing successful HMO plans that provide access to care while controlling cost and sustaining our medical community. It is important to note that the HMO plans in our area are managed locally; therefore they are able to be sensitive to patient needs and provide more ready access to care.
The health-care crisis is indeed a crisis . . . and it promises to get worse. Our politicians tell us they are unlikely to address this problem meaningfully in an election year. Federal grants for implementation of the Community Wide EHR as well as optimal use of the more favorable reimbursements of the available local HMO plans will contribute to the viability of retaining and recruiting primary care physicians who are the lifeline of our whole medical community.
Our community can weather this storm more effectively if we stay informed and work together for solutions.
Dr. Dan Bibelheimer, a general practive physician for 31 years in Grass Valley, is the medical director of the Sierra Nevada IPA.
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