10: Quality General Practice of the Future
The crown of the building blocks is the template of the future. Few practices have achieved this ultimate goal: a daily schedule that does not rely on the 15-minute in-person clinician visit but offers patients a variety of e-visits, telephone encounters, group appointments, and visits with other team members
Clinicians would have fewer and longer in-person visits and protected time for e-visits and telephone visits. With a team empowered to share the care, clinicians would be able to assume a new role – clinical leader and mentor of the team.
Full implementation of this future template requires payment reform that does not reward primary care simply for in-person clinician visits. Some practices are receiving non-visit-based care coordination and pay-for-performance dollars in addition to fee-for-service reimbursement, payments that begin to support new modes of patient encounters. More transformative is to eliminate fee-for-service payments altogether and pay for primary care on a risk-adjusted comprehensive fee per patient with adjustments for quality and patient experience.
If primary care practices can reduce unnecessary emergency department and hospital costs for their patients, these practices could also receive a portion of the cost savings.