Editorial: Health care solutions start with education

Obamacare and its virtues and vices get all the air time, but the real threat facing the delivery of health care services in the United States is escalating costs, driven in part by a looming shortage of doctors, primary care doctors in particular.

The American Association of Medical Colleges estimates the country will be short 124,000 physicians by 2020, 37 percent of them primary care doctors – the first one most patients see when seeking medical care. In Washington, the projected doctor shortage 15 years out runs as high as 3,000.

Admittedly, an association of medical schools is hardly going to low-ball a number that will incent more interest in their programs. But even the Center for Health Policy at the Dartmouth Institute, which dismisses alarms about an overall shortage, concedes that more primary care docs will be needed.

Setting aside all the promise of a burgeoning health care research hub, the fundamental justification for a Spokane offshoot of the University of Washington Medical School is to graduate more physicians. The UW school has a reputation for being the top educator of primary care doctors.

But too many of those doctors feel they must move up the food chain to better-paying specialties. This week, Spokane Dr. Glen Stream told the U.S. Senate Finance Committee what might be done to encourage more primary care and how it might be packaged with other medical services to intercept disease early and prevent complications.

Stream, as president of the American Academy of Family Physicians, noted that the 240 million office visits to primary doctors outnumber those to the next highest specialty by 87 million. Those figures are startling. And Obamacare will pour millions more patients into the health care system.

Stream testified about several care models that produce better outcomes at lower cost, notably something called the patient-centered medical home: a base that coordinates care, counseling and referrals to specialists over time with the help of electronic medical record-keeping. Kind of a family practitioner for the 21st century.

Although fee-for-service, which rewards excessive medical care, has been faulted for increasing total health care costs, he said those payments have a place along a range of options that should also include care management fees for long-term patient supervision and quality improvement payments that recognize and reward better outcomes.

Another recommendation attempts to resolve a grotesque Medicare payments system with a Primary Care Incentive Payment that would give primary doctors a 10 percent bonus for some services. The estimated cost per doctor, $3,500, might help discourage the flight to more lucrative specialties, Stream said, citing one study that estimated the result would be a sixfold return to Medicare.

But to make all this work, we need more doctors enrolled in the UW campus in Seattle and the combined UW/Washington State University program in Spokane. We all want to be patient-centered patients.