The U.S. primary care system requires immediate reforms, according to a report released on Monday by the American College of Physicians, Reuters/Houston Chronicle reports (Reuters/Houston Chronicle, 1/30). The "State of the Nation's Health Care" report, which ACP releases annually, recommends reforms in how primary care is delivered, financed, organized and valued (CQ HealthBeat, 1/30). According to the report, the number of primary care physicians who retire currently exceeds the number of PCPs who graduate from medical school, in large part because of decreased income, increased costs and more demands from health insurers. "Primary care is on the verge of collapse," ACP said in a statement, adding, "Very few young physicians are going into primary care, and those already in practice are under such stress that they are looking for an exit strategy." According to ACP, PCPs -- "the bedrock of medical care for today and the future -- are at the bottom of the list of all medical specialties in median income compensation."

Recommendations
The report recommends new reimbursement practices for Medicare and private health insurers that would place PCPs in charge of patient care and provide patients with more responsibility for their own health. "Medicare will pay tens of thousands of dollars ... for a limb amputation on a diabetic patient, but virtually nothing to the primary care physician for keeping the patient's diabetes under control," Bob Doherty, senior vice president for ACP, said (Reuters/Houston Chronicle, 1/30). The report also recommends that Congress revise the formula Medicare uses to determine the value of physician services. "Our proposals address the way Medicare fees are determined, how payments are updated and how to assure that pay-for-performance programs provide sufficient incentives for quality improvement and care coordination" by PCPs, ACP President C. Anderson Hedberg said (CQ HealthBeat, 1/30). In addition, the report recommends that physicians receive reimbursements when they use e-mail to consult with patients on minor and routine issues to help reduce the number of expensive office visits. "If these reforms do not take place, within a few years there will not be enough primary care physicians to take care of an aging population with increasing incidences of chronic diseases," Vineet Arora, chair of the ACP Council of Associates, said (Reuters/Houston Chronicle, 1/30).

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