Primary Care Medicine/Pathology

Primary care medicine

Provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community

Primary care visits

71% to general medicine
25% to neuromusculoskeletal
4% OB/GYN

Modern healthcare and primary care medicine

Progress in medical technology and increased knowledge

Medicare and Medicaid (1965)

Guaranteed health care for elderly and poor
Rising costs in both sectors

Health Maintenance Organization Act (1973)

Gave financial and legislative support for HMO’s
Federal grants and loans to encourage HMO’s
Requires employers offering traditional health plans to offer an HMO option

Enrollment for HMOs and PPOs from 1980-1990

45 million

What do HMOs offer

Comprehensive, prepaid health coverage for hospital and physician services with specific providers
Gives cheaper prepaid health plans access to the employer based insurance market

Tax Equity and Fiscal Responsibility Act

Diagnosis-Related-Group (DRG’s)
Flat rates replace '“charge for services”

Resource Based Relative Value Scales (RBRVS) 1989

Physician work
Practice expense
Professional liability

HMO: “The Gate Keeper”

Meds
Imaging
Blood work
EMG
Specialists
PT

Fall of Gatekeeper HMOs (2000s)

Backlash from public/politicians
Patient complaints increased
Discontent when denied medical services
Questioned financial arrangements: insurance agent vs patient advocate
Pressure on PCP = fewer PCPs

Primary care provider’s dilemma

An abundance of patients: baby boomers and the aging population
Patients with ongoing medical illnesses require extended appointments and typically more time with the physician
Still must see enough patients to be financially viable
Still must spend enough time with each patient

Primary care: physical therapists add value

Neuromuscular and musculoskeletal conditions

Primary care PT models

US Army model
Kaiser Permanente model
VA model

US Army model

Triage model

US Army model: privileges

Can order medical images
Can restrict soldiers to quarters
Can prescribe specific analgesic and NSAIDs

US Army model: outscomes

Effective
Safe
Efficient

VA model

Interprofessional primary care team

VA model: role of the PT

Eval and triage Msk conditions
Consults
Patient education
Provisions of equipment