aton499lIn the movie “I Robot,” there are these robots. The robots perform many tasks necessary for the survival of the society. They took care of old people. They took care of sick people. They probably filled out paperwork to get folks those “Rascal” scooters. The robots, as the story unfolded, often felt under appreciated.  In fact, it turns out they felt themselves to be superior to humans in many ways.  It wasn’t until the robots were completely incorporated into the fabric of society, indispensable, as it were, that the humans figured out that they had a plan.

We just had the meeting of the Family Medicine department chairs. Harold Miller, our keynote speaker, challenged us to go to our Deans. He pointed out that us saying to the Dean that “Family Physicians are the solutions to America’s health care problem so we need more resources to teach them” is not going to get us a lot of traction in these challenging times. This is likely to be true even if we say it really loudly or like we are really sincere. He suggested that what we need to do is walk into the Dean’s office and ask “How may I be of service?”

The following is a list service that should be provided by Departments of Family Medicine under the changing payment model. As we perform these services, we potentially become indispensable to  the Academic Health Center:

Directly Impact the AMC/Hospital Bottom Line:

  • Reducing readmissions to avoid hospital penalties
  • Reducing/controlling post-acute care costs (Episode payment and Medicare Spending Per Beneficiary (MSPB) will create accountability for total costs)
  • Reducing low-paying/uncompensated admissions (e.g., chronic disease admissions, Medicaid/uncompensated admissions)
  • Attracting and managing a large base of primary care patients (What can FM do to improve the patient experience of care, connect the medical center to a network of community PCPs, etc.)

Coordinate Primary and Specialty Care

  • Making the most effective use of specialists (e.g., reducing overuse of specialists for minor conditions/patients inappropriate for procedures, increasing use of specialists for effective diagnosis and appropriate procedures)
  • Managing care for complex patients (e.g., coordinating roles of multiple specialists, effectively managing in-home care, dealing effectively with end-of-life care)

Reduce Costs Through Improved Primary Care

  • Improving screening and preventive care to avoid high-cost conditions/treatment
  • Reducing unnecessary and duplicative testing
  • Improving maternity care outcomes for Medicaid patients and coordinating maternal and primary care (e.g., better pre-pregnancy care, better prenatal care, and better continuity of smoking cessation, etc. after pregnancy)
  • Reducing medical and non-medical costs for employed patients (e.g., reducing time away from work for commercially insured patients)

Adapt Family Medicine and other primary care efforts to PCMH, ACO, and Other Value-Based Payment

  • Organizing team-based primary care
  • Providing patient-centered, non-visit based care