Primary Care Docs Need Room to Breathe

That’s what L. Gordon Moore told a packed house Thursday at the AAFP annual meeting. Overworked, overstressed docs who truly want to deliver superb care to their patients need to find room to breathe in order to be able to do so. What does he mean by that? Simply that primary care docs must get away from environments that promote (or even insist on) volume-driven care if they want to transform their practices so they can provide care that truly meets patients’ needs. Such a practice, “the ideal practice model” Moore and colleagues have developed, focuses on continuity of care, real access for patients, efficiency (in terms of the practice’s organizational set-up; the idea being that a patient’s time in the office isn’t wasted by inefficient business and administrative practices), relevant information, and enabling patients to confidently provide self-care.

That a practice would (and should) be characterized by those attributes seems obvious, but Moore and a growing chorus of primary care physicians contend that the current healthcare environment prohibits many practices from delivering quality care that, in Moore’s words, “helps patients follow through on their intention to be healthy.” Part of the problem Moore identified is the false conflation of effective primary care with excellence in disease management. Focusing on disease-specific benchmarks of “quality” (such as percentage of patients who meet A1C targets) ignores far too many aspects of what makes primary care the lynchpin of our healthcare system. Excellence in disease management, while important, concedes Moore, is only “one piece of the complex tapestry” of primary care.

In addition to finding room to breathe (whether by making the practice more efficient, reducing overhead, etc), practices need to implement IT tools that support quality care (Moore stressed that definitely does not necessarily mean complex, comprehensive EHRs that are seemingly designed to optimize billing and coding rather than support quality care). Moore also stressed the importance of measuring and compiling real data regarding practice performance and quality indicators, being clear to note that there is often a vast difference between what payers may define as effective quality care and what patients define it as (this goes back to his point about disease/organ system-focused care failing to translate into practice excellence). Finally, practices that want to transform the way they provide care have to be willing to try new ideas. A key part of this is communicating with like-minded peers, a process greatly facilitated by the Internet. Physicians interested in learning more about the Ideal Practice Model can visit to watch a YouTube “how-to” video, read a collection of articles that have appeared recently in the Wall Street Journal and other publications, download a .PDF file that more fully explains the concept of “breathing room,” and sign their practice up to participate.