Improving Outcomes to Provide High Quality Care

Don’t try to legislate medicine - Moore

In his presentation, “Lessons from the Ideal Medical Practices Project, L. Gordon Moore, MD, reviewed the importance of improved patient outcomes, improved patient experience of care, and reduced per capita cost of health care. Literature supports that the population who receives good care from primary care physicians generally have a better overall outcome at per capita cost. The problem with the cost structure is that it’s not supportive. Insurance companies are being rewarded more money for the sake that they are large—the paradigm is that “bigger is better.”

It is important to educate physicians how to do things differently; without leadership and policy support it’s almost impossible to delivery high quality care. There is a need for physicians to invest in resources and spend money to set up health care technology; however there is no ROI unless it drives a high volume of patients to the practice. Moore said that this is a fundamental problem physicians are facing.

The problem with the US health care system is that it is specialty driven. What physicians and patients need to understand is that primary care plays an important role. The difference between a primary care physician and the rest of the health care system is that they are the first point of contact with patients, develop a long standing relationship, offer a comprehensive scope of services, and are involved with coordinating care.

Moore said that good primary care is better than average primary care; however there is a difference between good versus bad primary care. Patients are constantly asking themselves, “Does this practice have access to quality care? Does going to this practice waste my time?” According to Moore, in-office wait time and delays is an indicator of office effectiveness.

What are the problems primary care physicians are and will be dealing with moving forward? Unfortunately we are moving toward a toxic policy environment that will affect quality care. There are inadequate resources, a shortage of primary care physicians, and trying to handle the administrative burdens. In order to deal with such issues, it is important to eliminate barriers to care, enable and enhance self management, provide a broader array of services, and coordinate care across the continuum. “Primary care is the main solution to our health care problems,” said Moore. “It is the foundation of the health care systems in the western world. We need primary care.” Unfortunately medical students look at the branches of medicine and if one seems to be more miserable than others, they are less likely to choose that branch. Many see the primary care workforce as unhappy, burned-out, ad receive less pay.

Moore said that it’s time for primary care physicians to consider how they can unmask patients’ needs that are going unrecognized. He asked the audience if they ask patients such questions as, “Do you know what to do if you miss a dose? Do you know what to do if your blood sugar gets out of control?” Questions like these will help physicians provide better are, which leads to happier patients. Moore said that positive experiences define the effective primary care physician.

When discussing health care technology, Moore agrees that it improves patient outcomes, but said, “I’m suspicious that an EMR in every practice is going to solve the nation’s problems.” He said, “Do not try to legislate medicine.” It’s not the lock of knowledge or enthusiasm; it’s the toxic environment outside of medicine that affects medical practices.