Is Primary Care Really Under Siege?

A panel at the Cleveland Clinic 2018 Medical Innovation Summit debates the role of primary care in the future, as the concept has come under siege because of shifts in attitude; faulty payment models; and the rise of wearable technology.

A panel during the Cleveland Clinic 2018 Medical Innovation Summit addressed the possible future of primary care. The concept of the primary care physician is under siege from a number of things. An uneven payment system, millennials seeking out other options; and the rise of wearable devices all play a role in the way primary care will be delivered in the future.

“I think we would all agree, and if we were to ask ourselves, when we had our last primary care experience, that it wasn’t particularly ideal,” Anil Jain, MD, VP & Chief Health Information Officer, IBM Watson, said during the panel. “The average patient, when they’re talking to their primary care doctor has about 11 seconds to get their chief complaint out, before they get interrupted. The average primary care doctor has about 15 minutes with a patient and most of them spend most their time on the [Electronic Health Record] than face-to-face.”

Physicians also spend nearly 90 minutes after work, reviewing EMR files according to a 2017 study published in the Annals of Family Medicine. This phenomenon is known as Pajama time and helps contribute to physician burnout.

“We know that primary care is under siege,” said Jain, who also served as the moderator of the panel. “We have a lot of transformation happening in health. Primary care doctors and primary care practitioners are being asked to deliver high quality and high value care. But they’re not being given all the necessary tools to do so.”

Peter Antall, MD, President & CMO, American Well, noted that there were segments of the population, such as millennials and some males, that did not have a primary care physician. He added that could lead to a disjointed kind of care that could be costly.

“When you don’t have that guide, that starting point for your healthcare journey, what ends up happening when you have an issue is problematic,” Antall said. “You end up at multiple urgent care centers. While primary care needs an upgrade or an update. I believe it is essential.”

Joe Schrick, Vice President Fitness Segment, Garmin discussed how wearables could fit into the equation of primary care.

“We’re taking the data collected from our wearables and we are moving it into applications for corporate wellness, patient monitoring, and applications for health,” Schrick said. “One of the things we see in the future … is looking at ways to lower the cost of healthcare by empowering patients with getting their own data. Then we want to find ways to get this data to the physician.”

Schrick added, “moving that data into the healthcare environment is where there is a huge gap right now. What we often say is over 99% of the time the patient is with the doctor, but 100% of the time that wearable is on a patient’s wrist.”

But an important part of the discussion about primary care should come from reimbursement, the panel said.

“Let’s not forget, a lot of what ails primary care is how its paid,” Nirav Vakharia, MD, Vice Chair, Population Management, Cleveland Clinic, told the audience. “Our reimbursement [system] is rewarding physicians for seeing patients every 15 or 20 minutes, so that we have to interrupt them every 11 seconds, so that we can get throughout the day, then have ‘pajama time’ to finish our notes. I think what we’re seeing is many of the big payors and employers are understanding this and understanding that there is data to show the more that patient is engaged in primary care the lower the overall cost of care is.”

Vakharia addressed the idea of millennials foregoing primary care and parts of the population that might gravitate more toward the concept.

He said, “while we’ve talked about how millennials values are changing -they’re more tech enabled and not wanting that relationship anymore - let’s not forget there are still tens of millions of Medicare beneficiaries and other people who are aging that still have trouble accessing primary care.”

Bonnie Clipper, Vice President of Innovation, American Nurses Association said that there could be a significant shift in how primary care is delivered.

“I happen to believe that we are going to see an increase in retail primary care,” Clipper said. “We probably can debate if that’s the best place for primary care to happen. I think we’re going to see a resurgence in that. There are a few companies that are not currently in that space that are probably just on the cusp of it.”

She added, “The other thing for me that is going to be an absolute wildcard is that the sleeping giants in this are going to be the Amazon/ Apple disruptors of the world.”

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