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.

Vernissia Tam gulped down half a glass of champagne at noon Friday and prepared to scream. She was about to find out what kind of doctor she would become, and where she would train. "No peeking," a Johns Hopkins University School of Medicine official told the Class of 2013. "The diplomas aren't printed yet. " After a countdown from 10 that took all of three seconds, Tam and her classmates broke the seals on letters revealing their fates, jumping into one another's arms for an embrace and congratulations.

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.

Maryland has received $2.4 million in federal funds to help primary care physicians provide better coordinated care to patients. The state was one of 25 that federal officials said on Thursday would receive grants. The hope is that by better coordinating care of patients, health problems will be caught before they become emergency situations. Primary care providers will lead a team of health professionals that will work together to treat a patient.  The award will also be used to identify areas with poor health outcomes so that health departments can better target patients in need.  This new program, which state health officials hope will drive down costs, will be further designed and developed over the next six months.

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.

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.

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.

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.

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.

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.

The state is attempting to make it easier for physicians to connect child and adolescent patients to mental health services and better diagnose those that have potential psychiatric symptoms. Under a new initiative, primary care physicians in Maryland will have access to mental health specialists at the University of Maryland School of Medicine and Johns Hopkins Bloomberg School of Public Health through a phone consultation line. Training on how to identify mental health problems in children will also be offered under the initiative and the state will create a better pipeline between doctors and psychologists and psychiatrists.

Chiropractor Alan K. Sokoloff, who was mentioned in a recent story about meningitis, stated that "lots of times, primary care doctors ... go the extreme route" ("Outbreak spotlights back pain treatment," Nov. 5). Lots? How many? I offer the kind of primary care he's talking about, and I would ask that any alternative provider who treats my patients show the evidence his or her treatment is effective. People shouldn't have to rely on just anecdotes or testimonials to be confident that chiropractic works, is safer and worth the money.

The federal Patient Protection and Affordable Care Act was intended to extend health insurance coverage to 32 million of the roughly 50 million Americans who currently lack it. Yet even after the law fully goes into effect in 2014, millions of Americans will still be hard-pressed to pay the premiums charged by traditional for-profit health insurance companies. If they are to benefit from the law, many of them will have to seek lower-cost alternatives to the for-profit insurers. Plans for new kinds of nonprofit health cooperatives, which provide members equivalent care at lower cost, are already on the drawing boards in about two dozen states, including Maryland, which recently received a $65 million federal loan to fund the establishment of the state's first non-profit health cooperative.

By establishing a health benefit exchange and expanding Medicaid coverage, Maryland is on a path to extend access to affordable health care to hundreds of thousands of individuals, families and small businesses. For our progress to be sustainable, however, the growth in health care spending must be slowed and brought into balance. According to the Kaiser Family Foundation, health spending in 1999 averaged $3,993 per person in Maryland, about the national average. Over the next decade, however, Maryland's per capita spending rose 88 percent to $7,492 in 2009, outpacing national growth by more than $500 per person.

Not so long ago mixing a shopping trip with a visit to the doctor might not have crossed most people's minds. But the concept has caught on quickly. Clinics located in drug stores, supermarket and retail stores are attracting a rapidly growing number of patients, according to a new study released Wednesday by research group the RAND Corporation. Researchers found that visits to retail medical clinics increased four-fold from 2007 to 2009. Visits reached 5.97 million in 2009, compared to 1.48 million in 2007.

The case for building a new teaching hospital inPrince George's Countyassociated with the University of Maryland Medical System got a boost from a health study released Wednesday, but the question remains how the county and state would pay for it. The report released by state and local health and government officials detailed the county's health problems and what the new $600 million hospital complex that would replace Prince George's Hospital Center...

  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.

In the mid-1980s when I was a graduate student in England, my parents came to visit and my mother ended up getting a first-hand look at socialized medicine. It was dad and mom's one-and-only trip to Europe -- a very big deal -- and I wanted to show them as much as I could. We crossed the English Channel to France and drove to see the cathedral at Chartres. The first night there, mom slipped and sprained her ankle. By morning, she couldn't walk and was in need of a doctor. We ended up at a hospital where, with no wait at all, she got X-rays and a friendly, highly competent female doctor checked her out and wrapped her leg. As we were leaving, my mother asked where she should pay the bill.

A historic week! First Johns Hopkins Hospital suffers a huge judgment ("Waverly family awarded $55 million in lawsuit," June 27) and then the Supreme Court upholds the entire Patient Protection and Affordable Care Act ("Reform moves ahead," June 29). I serve as secretary of the Baltimore County Medical Association, but I speak for myself. I am sorry there ever a bad obstetric outcome for a family. It is clear mothers can expect to earn millions of dollars by trying to have their baby at home, waiting two hours into an obstetric emergency, having an injured child, and suing the receiving hospital in an easy legal venue.