The good news: I provided superb and compassionate care to the patients, many of whom were quite complex, who I saw today.
The bad news: I ran behind and one of my scheduled patients left without being seen.
Primary care is tough. I can either do a great job or run on time, but can't do both. Maybe I could do it if I didn't take care of sick patients, but those are the patients who really need care.
Ok, so how to deal with this? One theory--the current one traveling around the country--is that hospitals and doctors should be paid by a capitated or global payment. This theory is based on the idea that such a payment mechanism will result in better coordinated care, with the primary care doctor empowered to act as the patient's traffic cop vis-a-vis the interaction with other participants in the continuum of care. If and when the accountable care organization beats the capitated budget, the surplus will be recycled back to the PCPs and others who made it possible. But I have explained before why this incentive mechanism is not likely to work. Certainly, it does not provide a precise enough signal to PCPs that it would cause them to add the kind of time Danny seeks to take care of patients.
There is a much simpler solution: Pay the PCPs more. Make it possible for them to have smaller panels of patients so they can spend the time they need to. Recognize that the value of their cognitive skills is equivalent to, if not exceeding, the skills of proceduralists who now get paid so much more. My theory--which has at least as much empirical support as the capitated ACO theory--is that society will save the extra dollars spent on PCPs in reduced hospitalizations and procedures.