My 25 years as a rural family physician have shown me that the major reason we save money through an effective primary-care medical system is that patients use their primary-care physician instead of the emergency room. In the ER, there are incentives to admit patients to the hospital or direct them to specialty-care physicians — especially now that so many physicians are owned by hospital systems.
Even though primary-care medical homes foster ER avoidance and reduce unnecessary hospitalization, primary-care physicians have not been given the tools or incentives to work effectively toward that goal. Instead, in order to demonstrate quality of our care for payors, we must spend our time documenting cholesterol measurements, electronically transmitting prescriptions to pharmacies and documenting eye exams and urine protein testing on our diabetics,
I served on a statewide committee from 1993 to 1996 that was charged to expand access, lower cost and improve quailty of care for Medicaid patients. We piloted the program in our practice in 1997, and our state Department of Health and Human Services concluded that it saved the state $1 million at the end of the first year on 1,100 enrolled Medicaid patients.
I couldn’t believe this until I realized that that it took only about 10 or 20 of those 1,100 Medicaid patients showing up in the emergency room to run up the $100,000 of unnecessary charges each month that cost the extra million dollars.
Despite the incredible savings of this physician-created Medicaid program, it was terminated by Gov. Mark Sanford. Lowering the cost of care does not create political contributions, but politicians tightly tied to Wall Street and the out-of-state managed-care industry can be expected to benefit from out-sourcing our $5 billion state Medicaid program.
South Carolina’s current political leadership is terminating all previously created medical-home programs in January and outsourcing our Medicaid program to the HMO industry. This same political leadership finds it wise not to support Medicaid expansion, forcing private businesses to pick up uninsured workers or terminate them due to escalating health-insurance costs.
Oscar F. Lovelace Jr., M.D.