Tag Archives: primary care

Mass. data show how reform could affect access

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

How will the masses of newly insured post-reform patients impact already tight access to primary care? The Boston Globe‘s Liz Kowalczyk has found some hints in the latest results from a Massachusetts patient satisfaction survey. The survey involved about 80,000 commercially insured patients and the data is from 2009.

According to new data from the Massachusetts Health Quality Partners, a coalition that includes doctors, hospitals, and health plans, 83 percent of adult patients said when they called their doctor’s office for care they needed right away, they always or almost always got an appointment quickly.

Fewer patients — 78 percent — reported that they always or almost always got an appointment for a routine check-up or after-hours help as soon as they needed it.

To add some context, Kowalczyk compared the results to numbers from the 2007 survey, which was conducted before Massachusetts had fully boarded the expanded coverage train.

Still, said Barbra Rabson, the group’s executive director, the survey showed slight declines in patient access to their doctors, which could be a warning sign of growing strain in the system. “We need to watch this very carefully,” she said.

In addition to the sort of health care access numbers that bear directly upon reform coverage, the survey also included typical consumer satisfaction-oriented questions. By those measures, at least, care in Massachusetts seems to be improving slightly. The one area of decline? Coordination of care.

24,000 Memphis patients rated their doctors

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The Healthy Memphis Common Table is an effort to help patients and providers take charge of improving the city’s health. It includes the results of about 24,000 patient ratings of 430 local primary care doctors, all conducted by the nonprofit Consumers’ Checkbook.

Manoj Jain, M.D., M.P.H., (bio) is on the table’s advisory committee and he, as part of its mission to publicize the effort, wrote a three-part series in the The (Memphis) Commercial Appeal on the results and potential of the survey. The first installment is the one with the broadest appeal, as it discusses survey results and consequences.

In the second installment, Jain profiles a highly rated doctor and includes his own musings on what makes a physician great. Jain then wraps up the series with anonymous profiles of two poorly rated doctors and further musings on how their ratings might be improved. Interestingly, Jain’s suggestions almost always focus on non-clinical factors such as office staff quality and communication skills.

Nurses push to make up for physician shortages

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Kaiser Health News’ Andrew Villegas reports that the nation’s 125,000-plus nurse practitioners (and physician assistants, certified nurse midwives and dental therapists) are stepping up to fill the void created by America’s shortage of primary care physicians.

The Association of American Medical Colleges projects that the shortage of primary care physicians will reach 46,000 by 2025 and it will only increase if health care reform efforts succeed and millions of Americans are added to the ranks of the insured, Villegas writes. Nurse practitioners typically handle basic services such as physical exams, common health issues and some drug prescriptions.

Debate over national health overhaul legislation has heightened the sense of urgency about primary care and given nurses ammunition for their argument. “The biggest group of clinicians that will be in shortage with universal (insurance) coverage will be those who provide primary care — and that’s what nurse practitioners are so extraordinarily good at,” says Mary Mundinger, dean of the Columbia University School of Nursing.

There is precedent: Massachusetts’ 2008 health insurance overhaul recognized the 5,600 nurse practitioners as primary care providers who would be reimbursed through private insurance and Medicaid at the same rates as doctors. The nurses, however, must work under written protocols that designate a physician who can provide medical direction.

Despite questions from the American Medical Association, proponents argue that practitioners, who are typically required to have a master’s degree in nursing and work under a doctor’s supervision, know their limits and have proven their competence and effectiveness over several decades.