Primary care serves as the cornerstone for building a strong healthcare system that ensures positive health outcomes and health equity. The function of primary care includes managing new health complaints that pose no immediate threat to life, managing long-term conditions and supporting the patient in deciding when referral to hospital-based services is necessary. A key aim is to keep people well, by providing a consistent point of care over the longer term, tailoring and co-ordinating care for those with multiple health care needs and supporting the patient in self-education and self-management.
But, why are hospitals inundated with patients who should be seen by their primary care physician? This blog post addresses how primary care can save our hospitals and reasons why primary care is unable.
1) Impact on Prevention & Hospital Admission
In the context of increasing prevalence of chronic illnesses, achieving high quality primary care should be a top priority.
Asthma, COPD and diabetes are three widely prevalent long-term conditions. According to the WHO, Asthma affects between 100 to 150 million people worldwide and causes some 180,000 deaths each year. COPD, according to the WHO, affects around 64 million worldwide and currently is the fourth leading cause of death worldwide, responsible for around 3 million deaths each year. Globally, around 422 million people are known to have diabetes. The condition is estimated to have been responsible for 1.5 million deaths.
Common to all three conditions is the fact that the evidence base for effective treatment is well established and much of it can be delivered at a primary care level. A high performing primary care system can avoid acute deterioration in people living with asthma, COPD or diabetes and prevent their admission to hospital.
Avoiding hospital admission is not only cost-saving but often preferable to the patient, as well. Many health care systems continue to struggle, however, in reducing use of the hospital sector for conditions which are largely manageable in primary care.
2) Impact on the Management of Health Problems & Care Continuity
An important feature of primary care is the continuity that results from an ongoing relationship with physicians who know their patients and their patients' health histories. Such relationships open opportunities for patients to disclose sensitive problems and for clinicians to discover favorable moments to provide counsel and advice.
Furthermore, primary care practices manage patient health problems before the problems become serious enough to require hospitalization or emergency services, thus, keeping patients with non-urgent problems out of the hospital.
3) Impact on Overall Costs
In addition to its relationship to better health outcomes, the supply of primary care physicians was associated with lower total costs of health services.
Areas with higher ratios of primary care physicians to population had much lower total health care costs than did areas with low ratios. Baicker and Chandra’s (2004) analysis demonstrated this to be the case. Their study shows a linear decrease in Medicare spending along with an increase in the supply of primary care physicians, as well as better quality of care.
In contrast, a higher supply of specialists was associated with more spending and poorer care.
The financial consequences of hospital overuse are steep. Given cost differences and the high number of avoidable visits, it is estimated that hospital overuse costs approximately $38 billion annually. Experts estimate that the cost of a hospital visit for a non-urgent condition is two to five times greater than the cost of receiving care in a primary care setting for the same condition.
But, Primary Care is in Decline
In 2008, some 240,000 primary care physicians represented 35% of the U.S. physician workforce in direct patient care. But this proportion, too, has been in decline. A major factor in this decline is the enormous growth in the income gap between primary care and other specialties during the past two decades. Growth of the income gap is significantly associated with fewer students’ and residents’ selecting primary care and with the growth of subspecialty training positions in academic hospitals. These trends have now become so pronounced that it is likely that the primary care physician workforce will not replace itself over the next twenty years.
Similarly, only 37% of 80,000 physician assistants are believed to be practicing in primary care.
Primary care remains the largest platform of formal health care in the United States: In 2006, 568 million visits were made to primary care physicians. This represented 57% of all patient visits. Despite the volume of care, primary care patient visits are estimated to be only 6%-7% of total health care spending for Medicare beneficiaries, and this percentage may be lower for the rest of the population. Income disparities leave primary care struggling to compete with more lucrative specialties, both as a career path for physicians and as revenue centers for training institutions.
Why is Primary Care Failing to Save America's Hospitals?
The rise in patient demand, fueled by an aging population and the growing burden of chronic disease, is outpacing the supply of primary care providers, which is compromising the system’s ability to deliver quality primary care services to all patients. Thus, hospitals are increasingly filling that gap.
For example, the inability of primary care practices to provide patients with timely appointments and after-hours and weekend care has driven patients to the hospital for conditions that arise or worsen during those hours. Likewise, when patients in need of reassurance are unable to make an appointment or even speak with their primary care provider, they seek care at the hospital.
Hospitals are the only place in the U.S. health care system where individuals have access to a full range of services at any time regardless of their ability to pay or the severity of their condition. Today, the hospital is becoming a primary resource for more and more people as the U.S. primary care system finds itself unable to meet the growing demand for care.
A large portion of hospital admissions fall into the category of avoidable use resulting from patients seeking non-urgent care or care for conditions that could have been treated and/or prevented by prior primary care.
Estimates of total avoidable hospital use range as high as 56% of all visits.
Avoidable hospital use is problematic from both a cost and quality standpoint. The high costs impact both patients and payers and create a drain on resources. Avoidable hospital use diminishes the quality of care; crowding, long waits and added stress on staff take away from patients in need of true emergency care.
More fundamentally, experts believe that for non-emergency patients the hospital simply cannot provide the continuity of care that the primary care system offers.
You can help save the system
Now you know what’s causing this primary care crisis. But, imagine if you had the opportunity to secure your health during such uncertain times. It may seem like there’s no light at the end of the tunnel but there is a solution and it begins with developing a relationship with one doctor who has the same goal as you; prevention and wellness.
For the cost of a monthly gym membership, you’re granted unlimited, all-day access to your doctor, no waiting room times, hour-long appointments, basic tests at no additional charge and more importantly, your relationship with your doctor is much more personal.
With total access to your own personal physician, you will have peace of mind knowing that someone is always there for you and your family when you need it most. The solution is called Direct Primary Care.
Over 10 years of statistics indicate that patients get better health for a lower cost when enrolled in a direct primary care practice. Patients spend 85% less out of pocket for their total cost of care compared with the same level and amount of care in a traditional setting. And, patients spend an average of 45 minutes per visit with their doctor compared with 8 minutes in the traditional practice model.
Furthermore, it’s calculated that patients experience a 50% reduction in emergency department visits, specialist visits, advance radiologic testing, and surgical procedures than traditional practices.
The decrease in preventable hospital use alone can save $2,500 per person, which is more than the annual cost of enrolling with a direct primary care practice. Here’s another eye-opening statistic. If 20% of the population switched to direct primary care than the entire U.S. population would save a total of $1.9 billion dollars annually.
Enroll with a direct primary care practice today!