Macy Foundation Recommendations on Primary Care Reform

Recently the Macy Foundation held a conference on issues concerning the delivery and payment of primary care services. The conference was co-chaired by two professors at Duke University and included 49 participants representing a broad range of views on primary care.

The conference report makes some astute observations, including the following:

We are facing an economic situation in which the current rate of rise of medical cost is unsustainable, and this situation is exacerbated by an aging population with higher care needs and expectations. These events have created a climate in which it is necessary and appropriate to question the models of care and health professions education on which we have relied.

I agree with this wholeheartedly. Among other recommendations submitted by the panel, this one makes the most sense:

. . . state and national legal, regulatory, and reimbursement policies should be changed to remove barriers that make it difficult for nurse practitioners and physician assistants to serve as primary care providers and leaders of patient-centered medical homes or other models of primary care delivery.

This is a simple and straightforward example of how mundane - - some might say pedestrian even - - changes in existing laws could support profound changes in health delivery and reimbursement. Sure, changing licensing laws is not as flashy as a hatching a "national plan." But in effect, rolling back laws instead of creating new ones would provide room for primary care providers to come up with different delivery models to meet patient needs without sacrificing quality. I don't know exactly what that model would look like, and neither does anyone in Congress. Which is why the model itself should not be legislated, but need only be given space to grow.

The health care market is suggesting that there are better and cheaper ways to delivery primary care. Laws and regulations stand in the way. Those laws should be changed.

THAT is health *care* reform. THAT is what will provide downward pressure on health *care* costs. THAT is what will actually address the "biggest threat to our nation's balance sheet." THAT is something that should get done.