Whether you choose to listen or read “A Tale of Dollars, Pediatrics And Late Night Calls About Infant Constipation” by pediatrician and bioethicist John Lantos in the May 2012 issue of Health Affairs, you'll find that his storytelling offers a view into primary care in the margins between academic medical centers and federally qualified health centers (FQHCs). Dr. Lantos characterizes his rich experiences with patients, hospital administrators and the health care delivery system.
I’m glad for the layout of the FQHCs mission, community governance and comprehensive approach to primary care. There are more than 1,000 FQHCs seeing 20 million patients; these centers are also a rich training ground for medical student and residents. Lantos' candid discussion of reimbursement models and safety net policy reveals the myriad challenges embedded within the health system. Cost-effective, high quality patient care seems to implode budgets creating political battle grounds. For example, night call by telephone with nurses allows doctors to sleep for the most part while acheiving the goal of comprehensive care without unnecessary visits to the Emergency Department as in the case of pediatric constipation. In these cases, Dr. Lantos suggests that the dilemma of revenue lost in the ED devalues cost-effective care in the health center. He suggests incentives and rewards for systems improvement and quality patient care for solvency.
One long hot summer, I did research where I reviewed over 100 pediatric medical records in the lower level of an urban academic medical center. I observed the value of well-child visits, follow-up phone calls and comprehensive treatment strategies that reduced ED visits most significantly in asthma cases. It was also interesting that rapid weight gain in some cases, perhaps due to medication, went unaddressed. I still agree comprehensive coordinated primary care can make a difference!
What’s your take?