Good news on Friday post. Once again, Medicare #ACOs composed of relatively more primary care clinicians outperformed (generated more shared savings per beneficiary) than those with fewer primary care clinicians in the CMS 2024 results released this week. This is a consistent annual result and seems like a relatively easy change that all ACOs can make to help improve their performance. I'm curious to see if the PC average is moving up, which might suggest learning is happening across the sector and patients are benefiting from better access. #primarycare David Muhlestein Zach Davis https://lnkd.in/eJ-uxxTj
There is no good news to report regarding future primary care years. The nation needs five sources to generate at least 400,000 future primary care years per class year over 25 class years to reach sufficient primary care. The rise from 125,000 to 250,000 during the 1970s helped, but since the class of 1980 the level has declined to 200,000 and below. Each class year the fixed in place finances fail primary care overall and especially in the 40% of the population with half enough. Each source fails to lower levels. Previously this has been due mainly to falling primary care retention - failure to enter and leaving too soon. Previously in the calculations for the future primary care year contribution, the career years and % active and volume adjustments for each source were held steady. It is more obvious that the design are shortening career years and % active in practice. The added burdens and distractions hurt primary care volume as does fewer and lesser delivery team members. This pessimistic projection of future primary care years for each source may be more accurate due to these deteriorations. It takes more graduates to equal the same primary care delivery over a career compared to the 1970s graduates.
CMS still suppresses primary care, mental health, and basics for 40% of the population via its Decline by Design health insurance plans. 45 - 50% of worst diseases, mental health issues, environments, employers, health plans, outcomes, and drivers of outcomes 40% of the population in 2621 counties permanently behind 25% of each of the basic specialties suppressed by less than 20% of spending over 42 years of designs Half enough basics as well as fewer and lesser delivery team members defeats 1. accountable care 2. the only innovation that matters - one on one with each patient 3. most and best members 4. trust in primary care as a career 5. recruitment and retention 6. primary care retention The funding to move less than 20% to 40% of primary care and basics spending is a best move for health equity, health access, and all of the above denied and declined by design CMS has demonstrated that it does not understand most Americans most behind or how their plans cause more harm by paying too little and by paying less as levels of county workforce go down and by forcing higher costs of delivery that it does not cover.
Only the new Medicare and Medicaid designs 1970 to 1980 1. Boosted spending 2. In counties with concentrations of elderly and poor 3. Tipped the financial design from lacking to solvency for broadest generalists 4. funded the massive expansion of FM from 0 to 3000 annual graduates with best distribution including 30% in rural areas (half that now and half the primary care retention also) 5. built up hospitals in the 2621 counties most behind HCFA/CMS since the 1980s has torn this down as well as the future primary care year contributions The future primary care year was calculated from databases and reports for each source for each class year 1970 to 2010. This was multiplied by the number of graduates in each class year. The 5 source contribution was summed to get this graphic. The role of policy and CMS is quite clear The managed care panic did result in more entering in the mid 1990s but represents and overall decline due to the rebound Cuts, higher costs not covered, more burdens, and lost revenue sources can only lead to further decline After 2010 the primary care retention over a career is a projection as the data is not fully known, but continued retention declines are expected, and are usually worse than projected
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7moEven the optimistic projections are depressing for IM, NP and PA. The primary care workforce is changing as experienced MD DO NP and PA are replaced by low experience NP and PA. The financial design continues to decline which means not all leaving can be replaced and the deficits will worsen fewer and lesser team members. Each year we set new records for the least experienced primary care workforce in our history. The financial design does this for all the poorly supported front line careers and the massive expansions of NP and PA shift their workforce to higher proportions with no or low experience. To reach 400,000 future primary care years it will take more and more graduates with only 2.5 to 4 future primary care years for NP and PA. IM has collapsed. FM is cut in half. Peds and IM have poor distribution. Only the filled family practice broadest generalist positions distribute at 36% for the 40% of Americans most behind, but fewer are supported and fewer stay. Sufficient primary care from NP alone would require 154,000 annual graduates - about 3 times the current 50,000 graduates 400,000 future primary care years is impossible with the current financial design defeating years, activity, volume, and primary care retention