Primary Care

State health officials have approved a plan by CareFirst BlueCross BlueShield, the largest insurer in Maryland, to financially reward primary-care physicians for improving patients' health outcomes. Under the plan, doctors are eligible for a 12 percent increase in reimbursements just for enrolling. They become eligible for greater rewards by treating patients with the most chronic conditions. Doctors can earn $200 for devising care plans for patients and $100 for monitoring the patient's progress.

The Supreme Court's ruling on the Patient Protection and Affordable Care Act, expected in June, will determine the future for countless Americans. Health care reform debates have elevated the plight of millions of uninsured Americans to the national consciousness. However, the physician workforce that would be needed to care for millions of newly insured people deserves equal attention. There is a growing shortage of primary care physicians in the U.S., and it has been forecasted for decades.

Gov. Martin O'Malley signed legislation Tuesday to allow Maryland's nurse practitioners to cut bureaucratic delays and start practicing more quickly, a move providers hope will help alleviate the state's primary-care doctor shortage. The law streamlines the bulky credentialing process required for nurse practitioners to treat patients in Maryland. A process that now requires approvals by separate boards of doctors and nurses –- and can take up to six months — will be shortened to about a month, cutting the standard 19-page working agreement between nurses and doctors to a single page.

A program to improve healthcare in minority areas and reduce health disparities was approved by the General Assembly over the weekend. The pilot program, which now goes to Gov. Martin O'Malley for his signature, would offer tax breaks and other incentives to local health departments and community groups for their programs in these underserved areas - labeled as Health Enterprise Zones. “Every Marylander, of every race, ethnicity, and nationality, in every part of our state, should have the chance to live a healthy, productive life,” said Lt. Gov. Anthony Brown, who pushed for the administration bill.

Children's Hospital said yesterday it will make its first venture into primary care, adding three doctors who will include "complementary" techniques such as acupuncture.Robert A. Chrzan, president and chief executive officer, said, "We believe primary medicine becomes the basis for a number of things you need to do," including a future focus on "wellness." Strong practices in family and internal medicine, he said, can lead to more specialist physicians seeking privileges at the hospital and to more referrals of patients, for both inpatient and outpatient care.

With heated debates about reforming health care swirling across the country, professors from the University of Maryland's graduate schools told more than 200 students about how proposed changes might affect their future careers in medicine, dentistry, nursing, law, pharmacy and social work at a panel discussion Thursday night in downtown Baltimore. All the professors agreed that the U.S. health care system needs to be reformed. "We do need to control spiraling costs, but we don't want to do that at the cost of stifling innovation," said Dr. Mandeep R. Mehra, professor and head of cardiology at the University of Maryland School of Medicine.

I read your story on Andy Harris and the support he is engendering from the anesthesiology community ("Doctors inject thousands into Harris campaign," Sept. 27). You seemed to portray the situation as a struggle between doctors, who support Andy Harris, and nurse anesthetists, who support their own right to be independent practitioners. As a primary care physician, I can tell you that I, and many of my colleagues, support neither camp. Both anesthesiologists and nurse anesthetists earn too much as it is. Politicians give a lot of lip service to primary care, yet in our present environment very few medical students are entering primary care fields due to low earnings.

Congressman John Sarbanes had an excellent letter on the shortage of primary care physicians in Maryland (Readers respond, June 18 Baltimore Sun). His proposal for a public service loan forgiveness option is a step in the right direction to encourage physicians to enter primary health care practice. However student loan burden is a vast understatement of the true costs of becoming a primary care physician. In addition to medical school tuition, there is forgone income for four years of medical school, reduced income for three years of residency training and accrued interest on all of the above amounts.

Before serving in Congress, I worked closely with physicians and other health providers throughout the state of Maryland. Unfortunately, the shortage of health professionals, particularly primary care physicians, is a problem that has been building for many years. A recent article in The Sun, "Medical schools don't produce enough primary care doctors, study says" (June 16), drew attention to this problem and accurately pinpointed some of the reasons for it. Medical school debt can be a severe burden for young physicians.

I thank Dion Rudnicki of IBM for praising primary care ("A medical 'home' for every patient; Maryland is moving in the direction of more personalized, better-coordinated care," Commentary, July 13) It is the sine qua non of a solvent system. I don't see how IBM will succeed at recruiting primary care providers to Maryland when Johns Hopkins is losing them. My sister-in-law left Hopkins a year ago for 50 per cent better pay in Pennsylvania. Doctors pay represents only 6 per cent of health care cost, and most of that goes to specialists.

With a far more contentious hearing than expected before the Supreme Court, President Barack Obama's Affordable Care Act (ACA) could be struck down by a sharply divided court when it rules in June. If that happens, insurance will continue to be priced beyond the means of many. It is therefore prudent to look at possible alternatives for these Americans. Fortunately, a proven model exists today in Howard County: the Healthy Howard Health Plan. With some changes to its financing structure, it could emerge as a viable option for Americans who will not be able to afford to buy insurance should the ACA be struck down.

The state of Maryland is seeking doctors willing to practice in needy areas of the state, in exchange for up to $50,000 to repay student loans. The Maryland Loan Assistance Repayment Program was launched in 1996 and 157 primary care doctors have gone through the Program. Currently, 30 are employed in Baltimore city and county and Anne Arundel, Garrett and Worcester county. “Having a sufficient supply of primary care physicians across the state is critical to improving the health status of Maryland citizens,” said Dr. Joshua M. Sharfstein, secretary of the state Department of Health and Mental Hygiene , in a statement.

The U.S. New & World Report graduate school rankings  are out and Johns Hopkins University has moved up from 3rd to a tie for 2nd with the University of Pennsylvania. They were behind top-ranked Harvard University. But they beat out Stanford University and the University of California-San Francisco. The University of Maryland was tied for 37th with Oregon Health and Science University, moving up one slot from 38th. There were 126 accredited medical schools and 23 accredited osteopathic medicine schools included in the rankings.

Stuart Butler's op-ed ("An enterprising approach to health," Feb. 29) on what our proposed Health Enterprise Zones (HEZs) can learn from urban "economic" enterprise zones is a valuable critique. His focus on incentives, innovation and community partnerships echoes the strengths of our legislation, the Maryland Health Improvement and Disparities Reduction Act. Like economic enterprise zones, we intend to blanket a distressed community with incentives that draw in the expert people and quality services needed to address a specific problem: health disparities among underserved communities.

Kaiser Permanente will open a new medical facility in Lansdowne next year as part of a long-term strategy to double the number of patients it serves in the Mid-Atlantic region in the next decade. The health care provider said Wednesday that the 130,000-square-foot building will take a one-stop-shopping, approach, with many specialty services offered under one roof, much like California-based Kaiser's facilities on the West Coast. Kaiser also will build three other new facilities by 2013 in Montgomery County, Fairfax County, Va., and Washington.

The University of Maryland School of Medicine will use a five-year $877,000 grant  on a program to increase the number of students who enter primary care fields. The school said Monday it will create a primary care track that will allow students to work one-on-one with faculty from family medicine, pediatrics, internal medicine and other primary care specialties. The new program is being developed as health care reform is expected to put further pressure on primary care doctors.

  In response to the article, "ER visits might hit high hark," which ran the week of May 26, I agree wholeheartedly that the emergency room is not the ideal place to be treated for minor injuries or illnesses, nor for care that should be provided at lower-cost facilities, including urgent-care centers and primary-care practices. However, while the article encouraged individuals to seek medical attention for minor illness and injury from urgent-care centers, it totally overlooked the role that primary-care practices play in limiting unnecessary trips to the ER through comprehensive and cost-effective preventive and acute care.

CareFirst BlueCross BlueShield is offering primary care doctors a 12 percent increase in reimbursement for preventive care ("CareFirst's promising idea for primary care," Sept. 23). Primary care doctors are expected to draw up care plans, have in depth encounters with their patients and follow their patients more frequently to be eligible, and if they show good outcomes with less hospitalizations and surgeries for the same patients, they will be rewarded up to 80 percent of the savings in cost that CareFirst anticipates it will reap from this program.

Allow me to reduce your 110 column inches on Mark Midei to the crucial one: "Reviewers saw 30 percent narrowings when Dr. Midei saw 90 percent. " ("Mark Midei fights for medical license, exoneration," Dec. 10.) The rest is rhetoric. A key role of primary care physicians is to prevent unnecessary procedures by specialists. This is impossible if the patient is sucked through an ER evaluation and stenting procedure like a goose through a jet engine, without ever calling the patient's physician.

With a potent mix of excitement and idealism, we set out to become physicians serving on the front lines - primary-care doctors who would be the first point of contact for patients we would follow over the course of a lifetime. Yet throughout our training, the ideals of a career in primary care have begun to fade as strong financial, administrative and lifestyle considerations push us steadily toward specialization. As the United States struggles with a shortage of primary-case physicians, the pressure to veer from general practice represents a systemwide failure to supply the well-trained primary doctors our communities deserve.