CAMBRIDGE, MA – The New England Healthcare Institute's recently released report, "Remaking Primary Care: From Crisis to Opportunity," highlights the issues surrounding the primary care physician shortage and offers recommendations to alleviate the problem.

While the recommendations are sound, some of the report's findings that directly impact the PCP shortage need to be brought to the forefront, said Ben Isgur, director at PricewaterhouseCooper's Health Research Institute.

"The report was very well done in terms of laying out the issues," he said. "Some of the solutions are going to be more helpful for the type of care that patients receive and some are strong on increasing supply and access to primary care."

While the report mentioned increasing the number of medical schools, Isgur said the recommendation should go one step further. Medical schools need to expand or build in, or as close to, medically underserved areas because most physicians practice within 100 miles of where they went to medical school, he said.

The NEHI report's recommendation to improve pay-for-performance (P4P) is critical, Isgur said, but changing the reimbursement system ultimately will impact the supply side. "We don't pay our PCPs enough," he said. "We need to change the reimbursement system."

Isgur advocates payment reform that eliminates paying physicians for volume and replaces it with paying for quality. P4P initiatives are addressing this issue, but it is only part of the solution, he said.

Instead, Isgur recommends moving to a system where a single payment covers a procedure and its post-acute care. Geisinger Health System in Danville, Pa., boasts a "heart surgery warranty," he pointed out. "That's a great financial incentive to get care right the first time and a great example of changing the reimbursement system," said Isgur.

Primary care team training and patient-centered medical homes are great ideas and would drive higher-quality care, but Isgur noted that they would not directly increase access or solve the PCP shortage unless different types of reimbursements and financial incentives are a component of the concepts.

New sites of care that offer primary care services expand access by leveraging non-physician clinicians or physician extenders, but there is also a shortage of advanced practice nurses to fill in for PCPs, he said.

"We really have to ramp up both areas in order to meet those needs," Isgur cautioned, noting that a rise in concierge medicine, in which patients pay an annual fee to physicians, would drain too many PCPs into this type of practice and further increase the severity of the shortage.

Healthcare information technology creates virtual capacity when physicians implement electronic health record systems by driving down administrative tasks such as gathering patient data, Isgur said. The efficiencies gained means physicians can see more patients on a daily basis, especially if they embrace e-mail consultations.

While Isgur believes it could take between two to five years before physicians would see ROI through efficiencies and patient safety, the subsidies, and later the reimbursement penalties, within the HITECH Act will drive adoption now.

Overall, the industry needs to move from volume to quality, charge one global payment for procedures, fundamentally change some of the PCP reimbursements and increase those reimbursements in some areas, Isgur said.

While these issues were touched on in the NEHI report, they need to be in the forefront if the healthcare industry ultimately wants to solve the PCP shortage, he concluded.