future of primary care
Posted by Pam Arnsberger on Dec 08, 2016
Announcements and reminders
Rotarian of the week is Al for not being at this meeting
February 3RD is Rotary Night at the Warriors. See Al for tickets.
Speech contest is February 23rdiI
On Jan 3rd the International Rotary president will speak at the Doubletree Inn. We plan to get a limo to go over. It will leave at 5:00 or so.
Tim said the check has been delivered for the stop signs we donated to the Rio del Mar Parents Alliance.
Red badge requirement been reviewed (going from red to blue). New requirments are available from Al.
Keith announced that his Christmas party was a great success. He thanked Sheri de Cameron and Michelle Bagley and Art Dover for their help.
Brenda said we are going to have an ad in the Aptos Times with congratulations to them for 25 years.
Primary care provider Dr. Motyka spoke to us about the future of primary care. She is a family practice physician and a licensed acupuncturist. She has staff privileges at Dominican
She spoke about the bewildering array of challenges right now in primary care.
Primary care provider Dr. Motyka spoke to us about the future of primary care. She is a family practice physician and a licensed acupuncturist. She has staff privileges at Dominican
She spoke about the bewildering array of challenges right now in primary care. She said 100 years ago all MDs were generalists, trained as apprentices and not science based. Between 1916 and 1930’s medical schools were established, shaped by the pharmaceutical industry. Then specialization becomes more common.
As a reaction, family medicine began in the 1970’s and focused on the family as a system and a focus on prevention and early identification are a priority, but fewer and fewer are going into family practice. It takes 7 years and a $100,000 debt plus residency. Another problem is reimbursement. During WWII the health insurance industry grew, but the market is now broken and there are no feedback loops. There are biased payments towards procedural medicine and Medicare pays by the procedures so a family based practitioners must see more patients. She predicts there will be a shortfall of about 30,000 family practice physicians in the next few years
In the 1980’s the Knox Keene Act allowing for-profit practices forced hospitals and doctors into cost effectiveness which produced a lot of paperwork. Shortly after came the electronic medical record which was a blessing and a curse. We ended up with a lot of private silos and no national data. There is also a problem with medical records.. not really shared easily. Physicians must input data which takes a lot of times and records are designed to maximize reimbursement, not be a true medical record. As a result, family practice MD’s look for shortcuts or the 7 minute office visit.
Dr. Motyka said that Obama care did some good things, but they left the rates negotiable and here they weren’t enough. It is often hard to find doctors who will take it about the same reimbursement as MediCal). So currently Medicare is hemorrhaging family physicians due to MACRA (254 different quality measures) which was meant to improve quality. MD’s must comply or lose 10% of their reimbursement and forms can’t be directly read by government sources. She said that in the future, physician extenders will do primary care as well as multi-specialty practices such as PAMF and Kaiser.
The new trend is not towards standardization but being specific, but takes time and the reimbursement is moving away from that. Functional medicine is helpful and the thing that can turn all this around. So she opened her own practice where she gets to do it right and patients pay her to keep them well. She is known as a ‘concierge physician which may be the wave of the future.