Lack of investment in primary care decline hurts us all

The Milbank Memorial Fund is a wealth of information on US primary care. In particular, they have completed numerous studies on the importance and value of primary care. In addition, each year for the last several years, Milbank has issued a national scorecard on the state of primary care in the US. Unfortunately, these scorecards document a steady decline in primary care investment at a time when those resources have never been more important.

This quote from the report summarizes the issue:

”This combination of worsening primary care access and sicker patients has created a vicious cycle. Patients are driven to use more expensive services like emergency rooms, which raise healthcare costs and premiums, further reducing affordability and access. At the same time, overall healthcare spending continues to rise faster than economic indicators, while the crumbling primary care infrastructure receives only a small portion of these dollars.”

To be more specific, in 2022 US healthcare spending on primary care was under 5%. Other countries with advanced health systems and much better health outcomes spend on average 14% of health expenditures on primary care. Even more depressing is the fact Medicare only spends 3.4% of its funds on primary care.

Hopefully, the new administration will embrace these common sense facts and focus on improving primary care. Several options for that investment are possible. Go to www.thejourneys-end.org for more details.

Healthcare reform deserves our focus

This Wall Street Journal article powerfully portrays how trust has declined in healthcare. This sad outcome is the consequence of the ever growing burden of bureaucracy in the form of regulations and misaligned economic incentives interfering with the doctor patient relationship.

Our nation needs to wake up and acknowledge that perhaps health reform is as important as the Ukrainian War or peace in the Middle East. What we need is major change - not expanded ACOs or more value based care. Two key elements to that reform are:

1. Simplicity - healthcare is too complex

2. Restoring the patient physician relationship

For more information on these reform options go to www.thejourneys-end.org

ChatGPT understands the benefits of hospice care. Why don't we?

Why isn’t the Medicare hospice benefit more accessible given it improves patient care and saves billions annually for tax payers?

We inhibit hospice access with two unnecessary regulations:

1. The six month death certification by a physician. This rule has no clinical foundation. It should be replaced by one that says any patient with a terminal diagnosis is eligible for hospice.

2. The requirement that patients must give up regular Medicare in order to receive hospice. Again this rule has no foundation. In fact Medicare’s own research documents the benefits of allowing patients to have both regular Medicare and hospice simultaneously.

I recently asked ChatGBT to provide me with documentation for the benefits to society for enhancing access to hospice. This what it said:

Medicare achieves significant cost savings when beneficiaries choose hospice care, primarily by reducing hospitalizations, intensive treatments and emergency room visits. Studies estimate that Medicare saves between $2,000 to $7,000 per patient who elects hospice, depending on factors such as timing and diagnosis.

Overall, Medicare’s hospice benefit saves billions of dollars annually. A report from the Medicare Payment Advisory Commission (MedPAC) indicated that hospice care could reduce Medicare spending by approximately $3 billion to $5 billion per year, though savings vary depending on utilization patterns and patient demographics.

Recent studies have provided more detailed insights into the cost savings Medicare achieves through hospice care:

• Annual Savings: In 2019, hospice care resulted in approximately $3.5 billion in Medicare savings, equating to a 3.1% reduction in costs during patients’ last year of life. 

• Per-Patient Savings: For patients with Alzheimer’s disease and related dementias, enrolling in for-profit hospice care led to about $29,000 in Medicare savings over the first five years post-diagnosis. 

• Impact of Hospice Duration: Longer hospice stays correlate with greater savings. Patients receiving hospice care for six months or more experienced an average cost reduction of 11% compared to non-hospice patients. 

These findings underscore the financial benefits of hospice care for Medicare, alongside the quality-of-life improvements for patients and their families.

Hopefully someone from DOGE reads this common sense savings opportunity.