Hey readers – Jeanne Charters here. No “funny, isn’t it?” this month. The reason? When I read my daughter’s latest blog, I thought you should see it, too. I’ll be back next month.
Yes, I am a Painter, but I am also a Doctor
| By Stacia Charters Baker, M.D. | Jan 15, 2017 |This post is a bit political but it is how I really feel about taking care of my patients, my family and my country. Inherently, I am a believer that we, in America, should have a universal health care system. If you have not been following my blog for very long, and you are interested in learning more about why I so believe, refer to my blog from 11/2014. It was about a book called The Healing of America by T.R. Reid. You can see a summary of the research findings in that blog post.
Since I moved from Maine to Colorado, my practice has worked our butts off on a quality-enhancing project called CPCI.
Led by the CMS Centers for Medicare and Medicaid Innovation (CMMI), the Comprehensive Primary Care initiative (CPC Initiative) is a four-year, multi-payer federal program designed to test practice redesign models and a supportive multi-payer payment model. The program grew beyond four years, and we have just been chosen to complete the next chapter of that project. It has been A LOT of work for all of my staff. I am so grateful for the effort they were all willing to put in.
My practice is a rural practice comprised of large numbers of Medicare and Medicaid patients. With the Affordable Care Act (Obamacare), I have seen patients who have not had access to care for years. Their only means was to seek care when they were in crisis, which meant emergency-room visits with a potential for needing expensive hospital care.
With the CPCI project, we have been able to study our population and to identify those who are in need of extensive management. We have worked hard to see these patients frequently, and to educate them as to how to best manage their diseases. We have taught them how to eat well, how to increase exercise, be more compliant with medications, address barriers like poverty, lack of support or transportation. We have helped them solve their physical, emotional, mental and economic issues.
We have become a certified medical home and our patients are healthier. We have significantly reduced emergency room visits, hospitalizations, re-admissions to the hospital and unnecessary referrals to specialists. We have also worked very hard to improve communication between the primary care physician and the specialists as patients transition between the two.
In early 2015, CMS released the first evaluation report (innovation.cms.gov) of the CPC initiative. It reported favorable findings from the first program year (2013). CMS is pleased with the first-year findings, but anticipates it will take 18 months to three years for practices to truly transform and to see efforts on cost, service use, and quality. Here’s what the first report has found:
• Reduced total monthly Medicare expenditures without care management fees.
• Impacts were large enough to offset most of CPC initiative’s monthly care management fees.
• Results show a reduction in high cost areas such as hospitalizations, emergency department visits, and specialist visits.
We have just begun to understand from a primary care perspective how to reduce healthcare costs. This was made possible under the Affordable Care Act. It has not been perfect. In a country such as ours, it will take many years for the creation of a viable, sustainable health care system.
I do not believe the answer is in going back. I believe it is in continuing to build from what we currently have in place. Having less people insured will only cost us money. I believe we all need to be insured.
I worry about the repeal of the Affordable Care Act for my own personal reasons as well. Being a breast cancer survivor, it could become very difficult for me to obtain health insurance. Being the mother of a disabled son, I worry that he will lose the Medicaid coverage that he has and his Social Security. Being the mother of a son who has struggled with addiction, I worry that he will lose the mental health support, which has helped him to stabilize his addiction. He now has a skill that makes him employable. He is no longer in homeless shelters and he helps us to care for Lucas, my disabled son.
Ignoring these kinds of issues does not make us a stronger country. It does not save our healthcare system any money. I understand that I am powerless to really affect the outcome of what may pass with the coming weeks, which would be sliding backwards to create an even sicker and more expensive health care issue, but I wanted to share the perspective of one passionate American family doctor and citizen.
Stacia Charters Baker, M.D. | website: staciabaker.com