Journal ArticleDOI
Primary Care Physicians Should Be Coordinators, Not Gatekeepers
TLDR
This model would eliminate the requirement that referrals to specialists be authorized by the primary care physician or managed care organization and transform PCPs into coordinators of care, in which the goal of the PCP is to integrate both primary and specialty care to improve quality.Abstract:
Primary care gatekeeping, in which the goal of the primary
care physician (PCP) is to reduce patient referrals to specialists and
thereby reduce costs, is not an adequate system in which to practice
medicine. However, returning to the pre–managed care model of
uncoordinated open access to specialists is a poor solution. The
primary care model should be retained, but PCPs should be transformed
from gatekeepers into coordinators of care, in which the goal of the
PCP is to integrate both primary and specialty care to improve quality.
Changes in the PCP's daily work process, as well as the referral and
payment processes, need to be implemented to reach this goal. This
model would eliminate the requirement that referrals to specialists be
authorized by the primary care physician or managed care organization.
Financial incentives would be needed, eg, to encourage PCPs to provide
management of complex cases and discourage both overreferral and
underreferral to specialists. Budgeting specialists should control
excess costs that might be created by the elimination of the primary
care gatekeeper. Pilot projects are needed to test and refine this
model of PCP as coordinator of care.read more
Citations
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Journal ArticleDOI
Association of Lower Continuity of Care With Greater Risk of Emergency Department Use and Hospitalization in Children
Dimitri A. Christakis,Loren K. Mell,Thomas D. Koepsell,Frederick J. Zimmerman,Frederick A. Connell +4 more
TL;DR: Lower continuity of primary care is associated with higher risk of ED utilization and hospitalization and efforts to improve and maintain continuity may be warranted.
Journal ArticleDOI
Resolving the gatekeeper conundrum: what patients value in primary care and referrals to specialists.
Kevin Grumbach,Joe V. Selby,Cheryl L. Damberg,Andrew B. Bindman,Charles P. Quesenberry,Alison Truman,Connie S. Uratsu +6 more
TL;DR: To determine the extent to which patients value the role of their primary care physicians as first-contact care providers and coordinators of referrals, and whether problems in gaining access to specialists are associated with a reduction in patients' trust and confidence in theirPrimary care physicians, a cross-sectional survey was mailed to 12707 adult patients in California.
Journal ArticleDOI
Fundamental Reform of Payment for Adult Primary Care: Comprehensive Payment for Comprehensive Care
TL;DR: This work presents a fundamentally new model of payment for primary care, replacing encounter-based imbursement with comprehensive payment for comprehensive care, which establishes a new social contract with the primary care community.
Journal ArticleDOI
Comparison of a spatial approach with the multilevel approach for investigating place effects on health: the example of healthcare utilisation in France
TL;DR: This study examined whether analysing geographical variations across continuous space with spatial modelling techniques and contextual indicators that capture space as a continuous dimension surrounding individual residences provided more relevant information on the spatial distribution of outcomes.
Journal ArticleDOI
Continuity of Care: Process or Outcome?
TL;DR: Having a regular physician seems vital to the establishment of trust and is frequently cited as a core component of the Institute of Medicine's definition of primary care.
References
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Journal ArticleDOI
Organizing care for patients with chronic illness.
TL;DR: The challenge is to organize these components into an integrated system of chronic illness care, which can be done most efficiently and effectively in primary care practice rather than requiring specialized systems of care.
Journal ArticleDOI
A Multidisciplinary Intervention to Prevent the Readmission of Elderly Patients with Congestive Heart Failure
Michael W. Rich,Valerie Beckham,Carol Wittenberg,Charles L. Leven,Kenneth E. Freedland,Robert M. Carney +5 more
TL;DR: A nurse-directed, multidisciplinary intervention can improve quality of life and reduce hospital use and medical costs for elderly patients with congestive heart failure.
Journal ArticleDOI
The ecology of medical care
TL;DR: The current discussions about medical care appear largely concerned with two questions: is the burgeoning harvest of new knowledge fostered by immense public investment in medical research being delive...
Book
Primary Care: America's Health in a New Era
TL;DR: The most valuable chapter in the book defines primary care as the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.
Journal ArticleDOI
Variations in Resource Utilization Among Medical Specialties and Systems of Care: Results From the Medical Outcomes Study
Sheldon Greenfield,Eugene C. Nelson,Michael Zubkoff,Willard G. Manning,William H. Rogers,Richard L. Kravitz,Adam Keller,Alvin R. Tarlov,Alvin R. Tarlov,John E. Ware +9 more
TL;DR: Although variations in patient mix should be a major determinant of variations in resource use, the independent effects of specialty training, payment system, and practice organization on utilization rates need further explication.