Allen Dobson Jr., MD, a family physician in North Carolina and President and CEO of Community Care of North Carolina (CCNC) appeared April 9th before the Senate Committee on Health Education, Labor and Pensions to describe how the state of North Carolina has built a strong, community-based primary care system but yet doctors are facing chaos in his state.
As he explained, “Over 90 percent of the state’s primary care workforce participates in CCNC. This has resulted since North Carolina is paying a somewhat higher rate for reimbursements than other states, plus the fact that support is provided to primary care doctors by CCNC. Health informatics and low-cost care management platforms enable the application of population management across CCNC’s entire statewide footprint and improves the quality of care delivered.”
Dr. Dobson told the Committee, “This unique public-private infrastructure which covers all 100 of the state’s counties has helped the state have the lowest Medicaid growth rate in the country. According to Dr. Dobson, Community Care has saved nearly a billion dollars over a four year period in our Medicaid program.
However, as Dr. Dobson explained to the Committee, “The healthcare landscape has accelerated rapidly over the last 2-3 years and the doctors in the state are reeling. Our primary care medical homes are under stress and this will have a significant impact on the future primary care workforce”
Some of the problems that hinder progress in the state:
- Physicians are trying to figure out how to meet Meaningful Use requirements
- Despite buying into technology, doctors are inundated with paperwork and clerical tasks often turning physicians into data entry clerks
- Physicians have been promised enhanced reimbursement for becoming an accredited Patient Centered Medical Home but have yet to recoup their investment
- Physicians now have to decide whether to join or become an ACO and the price tag for start-up costs can go as high as $10 million
- Independent physicians currently are dealing with the rapid consolidation of hospital systems which is forcing them to take on salaried positions with large health systems
- With the rapid growth in healthcare technology platforms needed to provide remote monitoring and to control costs, vendors are paying visits to staffs with information promoting the latest app or care management solutions. The result is that the staff is required to become much more involved with equipment and technology issues which can take time away from the patient
Dr. Dobson provided the Committee with three recommendations. First, create an effective primary care pipeline and develop a continuous and coordinated medical education strategy, provide for payment reform now but on a larger scale focus on incentives to enable primary care doctors to form continuous relationships that will engage and activate patients to change behaviors, and lastly, enable the states to build statewide informatics infrastructure with the needed capacity in rural areas to really help independent practices.