Dear Reader,

I am baffled. I am miffed. OK, I am both baffled and miffed. First, a little background. House Bill 335 was just introduced last week in the Legislature by Representative Gara and several other legislators with bipartisan support of the concept. The name of the bill is, "An Act establishing a program and account for grants to support access to Medicare and primary health care services in shortage areas." The short title is "the Medicare and Primary Care Access Act."
 
Language in the bill notes that, "to increase access to primary health care services, the state should provide incentives by expanding the availability of nonprofit primary care clinics when the clinics can provide cost-effective help to solve medical access problems." The bill establishes a grant-making program so that grants can be made to non-profit primary care clinics in physician-shortage areas "that provides primary care services to needy persons and to persons 65 years of age or older who are recipients of medical assistance or Medicare."
 
This sounds to me like a darn good idea! There are 142 private non-profit Community Health Centers around this state that meet all those criteria and for years have been seeing the Medicare patients that the vast majority of primary care physicians in Anchorage won't see. The Community Health Centers are fully established, operational, and provide high quality health care to national standards. And that is despite chronic under funding, a skyrocketing patient load, and a disproportionally difficult and complex patient mix. These health care providers are heroes all in my book.
 
Who is Dr. George Rhyneer? Dr. Rhyneer and a group of physicians have this idea that they could develop a special Medicare clinic that perhaps could be seen as a model across the state and maybe the nation. This group seems to have received nearly all the media attention around this new bill. They just need a million dollars or so from the state to get it up and running -- kind of an experiment. It would be a very "efficient" design. That means that clinic physicians would see up to 50 patients a day! That is a lot of patients to be whizzing by the doc in a day, and in my view really raises red flags in terms of quality of care issues. Dr. Rhyneer claims this would not be as troubling as it sounds because there would be other providers, like nurses and medical assistants, who would spend a bit more time with the patients.
 
Another aspect of this experimental clinic would be that Medicare patients can only present one problem per visit. Apparently if they have two medical problems they have to make another appointment and come back again. This feature is designed to maximize clinic revenue in light of how Medicare reimbursement is structured. Medicare patients, however, are often characterized by multiple medical problems that interact in complex ways. This "efficient" revenue-maximizing feature also raises red flags and seems to fly in the face of a "medical home" model of treating the whole patient rather than the patient's parts.
 
I am not a physician or a medical provider of any kind. I am a public health policy guy. Maybe I am misunderstanding this or missing something. But on the one hand I see 142 existing, experienced primary care clinics that treat the whole Medicare patient and consider all medical conditions in a single visit, and then there is Dr. Rhyneer's "efficient" non-existent experimental Medicare clinic designed to maximize income. I am just not sure why spending state money on that idea is good public policy when there is a far better alternative already up and running and providing high quality care for Medicare patients. Give the money to the Community Health Centers. What do you think?

Lawrence D. Weiss PhD, MS
ldweiss@acpp.info