Rural Primary Care Medicine Efforts Sync with the FEC Efforts

Lonnie Schwirtlich MD, FACEP

FEC Section Secretary/ Newsletter Editor

There have been several recent not so surprising revelations that have come out of the legislative studies of healthcare.  One of which is that we need to get better primary care out to the public, especially in the rural areas. This is in addition to several other world shaking findings like allowing private equity and hospitals (which are run like or by private equity groups) to buy up physician practices is not good for patient care, physicians, and health care costs, nor is the consolidation of health care by these entities. 

With respect to primary care in the rural areas they are being trying to understand and figure out how to get primary care docs to number one, stay private and not get bought out by the big hospital groups but also how to get them to go out into the rural areas. 

First, the reason the offices of many doc specialties as well as primary care docs are selling out to hospitals are that they are not getting paid enough to stay in business with all the expenses involved in running a private practice.  If they sell out to a hospital organization, then the hospital association calls their facility a HOPD (Hospital outpatient department) and attaches a facility fee to the bill increasing it drastically, even though it doesn’t have any of the 24 hour requirements, EMTALA requirements, equipment availability and access requirements that has been used to justify legitimately the facility (maintenance) fee.  The simple solution to this problem is to stop allowing hospitals to consolidate these private offices into them (which they are working on legislation to do) but also take the difference between what they pay for the office and facility fee cost of a consolidated office and the private office visit, divide it in two or some multiple so the private office can stay in business by that increase in payment to the private offices. 

Second,  in order to get the primary care facilities to go out into rural areas and practice there either solo or in a group practice where they are on call 24/7 365 days a year, pass the emergency care improvement act or include it in a bill that encourages FECs staffed by board certified EM docs to go out in all those small communities so that at 5 pm to 8 am, the primary care and other specialties can turn over their after-hours call to the FECs docs.  Also, that bill includes increased reimbursements for those sites and practices that do this because it is more expensive to staff and supply those more rural facilities.  A primary care doctor is not going to be allowed by his mate and family, in most cases, to go out into a site where he/she is on call 24/7 and he/she has no home life.  That is a given, though there are some special people who do that.

They all are locked into this phrase of cost neutral which is that they cannot do anything that cost more health care dollars, but they have MBAs look at this and develop the numbers with no or minimal knowledge of the effects of these changes on health care itself which is what generates the costs effects. 

Just to look at the big picture, let us look at what this solves.

Taking care of any problem earlier almost always ends up costing less with less spent on initial care as well as avoidance of paying for the after care, such as CHF vs. thrombolysed MI, Bronchitis vs pneumonia and sepsis, CVA vs TIA because of lysis.  Improving primary care for everyone by encouraging good primary care in all communities both urban and especially rural, where the farmer rancher small town workers are much harder to replace is a major way of saving health care dollars.

Encouraging the establishment of Emergency Facilities in all the smaller rural communities would save vast amounts of health care dollars in many ways.  A FECs footprint is much less than a critical access hospital with the smaller less expensive build out costs and less maintenance costs.  They are now even allowing critical access hospitals to shut down all the other parts of the hospital except the ED and calling them Rural emergency hospitals which are essentially a FEC, but they have wasted all those health care dollars on building out the rest of the hospital only to have it fail.  If they allowed the FECs to use their facilities testing equipment for outpatient services, then the rural primary care docs could send the patients needing them locally to get those tests much earlier in the disease process and with less travel time and trouble for the patient so that they could affect treatment earlier and avoid more major complications that costs more health care dollars as well.

Additionally, by encouraging and aiding the placement of FECs out in the rural primary care needed areas, they would also be a fantastic solution for the already debunked statement that there would be an overabundance of EM trained docs by 2030.  We know that statement was erroneous from the start because if there really was an overabundance of EM doctors then everyone would be getting their care in the golden first hour of their disease or trauma encounter when it most effective.

I would like for everyone, when they get the chance, to talk this rhetoric to their neighbors, fellow health care workers, legislators and let us save health care dollars and improve medicine rather than decrease medicine like many present day solutions offer.

Lonnie Schwirtlich MD FACEP

FEC Section Secretary/ Newsletter Editor
Board member of NAFEC/TAFEC
CMO and Co-Founder of Physicians Premier Emergency Centers