21) What other issue is more important to increase primary care physicians in Vermont?

Having more time to spend with patients, more social workers to help with all the psychosocial issues we have to help people with and don't know enough about.

3/6/11 12:07AM View Responses

Increased reimbursement to primary MDs always implies reductions for specialists. While GPs deserve better pay, it is untenable to further reduce specialists compensation.

3/6/11 3:05AM View Responses

Respectable salary is THE most important. Every PMD should have a respectable base salary and incentives beyond that. PMDs who have scored well on quality measures such as NCQA (not insurance company data) should be paid more and be allowed to have less interference form insurers.

3/6/11 4:47AM View Responses

INCREASE PRIMARY CARE TRACKING IN MEDICAL SCHOOL, FORM A LINK TO OSTEOPATHIC SCHOOLS LIKE U.N.E., AS OSTEOPATHS TEND TOWARD PRIMARY CARE PACTICES

3/6/11 5:35AM View Responses

In my opinion, in order to get more primary care physicians, you've got to start with medical school. You can't expect a graduating medical student with a $200-250K debt to go out into the work force and make what primary care doctors are making, especially seeing how much the specialists are making. "It's not how much it's how different". Set up a system whereby primary care docs get their medical school loans paid off as long as they practice primary care for 10 years... craft a system that rewards those who go into primary care.

3/6/11 7:03AM View Responses

Less insurance burdens, more old fashioned style medicine with time to spend with patients,

3/6/11 8:46AM View Responses

change the malpractice to "No Fault" Insurance. Please tell me where the legislature finds in the Vt Constitution the right to regulate the medical industry. How about dentistry, law, food prices and the cost of fuel???

3/7/11 1:55AM View Responses

I feel strongly that the legislature should not coerce any physicians--primary care practitioners or others--to adopt electronic health software. I have two reasons for feeling this way: First, the quality of the scores of available software programs is generally poor--Are user unfriendly (meaning they are pitifully slow) and don't provide quality protections and reminder systems that are easy to use. The other reason is that it is ridiculous for our state government to encourage the adoption of scores of mutually incompatible software programs--We should all adopt a single piece of software so that we can communicate with each other easily electronically. The VA's VISTA system would be one of many possible options.

3/7/11 8:34AM View Responses

less hassle, more respect, higher reimbursement

3/7/11 9:28AM View Responses

The proposed patient medical home that will allow primary care physicians greater control to direct care of the chronically ill.

3/7/11 9:26PM View Responses

reimbursement is horrible. BCBSVT only pays 10-15% above medicare. there is no way to cover overhead.

3/7/11 10:35PM View Responses

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3/7/11 11:48PM View Responses

Reduce bureaucratic intrusion into the exam room. Less oversight of every little thing we do. It's maddening

3/8/11 12:07AM View Responses

get the disease management people off our backs

3/8/11 12:19AM View Responses

Malpractice climate

3/8/11 12:27AM View Responses

Single payer system would be strongly presferable. Get rid of managed care burdens and administrative hassles.

3/8/11 1:15AM View Responses

decent universal coverage from cradle to grave

3/8/11 1:28AM View Responses

being able to schedule by sense of patient need and physician duty, and not by economic necessity

3/8/11 1:47AM View Responses

single formulary easily available cme for non affiliated MD's

3/8/11 2:13AM View Responses

The concept that is coming forward that inorder to make a living we must take care or more and more patients (capitation) and be as efficient as possible remains an impossible task when all we have is burdensome prior authorizations (that always get approved) and increasing reporting of data. The rapid onslaught of all these changes to include the EMR, Medical Home is making Primary much less attractive. Personally if the State continues as they are I am reducing my practice and doing more consultative work that is far more rewarding and compensates better than Primary care. Our neighboring state of Massachusetts has a short supply of PCP and their enticement looks better to me all the time.

3/8/11 2:24AM View Responses

Primary care bills mostly E&M codes and VT medicaid reimburses these relatively well - generally above medicare (eg 99214 MCD $80 MCR $78) so that provider tax would be less advantageous to a PCP than to a specialist. Provider tax sounds alarming to me and I think would frighten off new PCPs. You really need to push the numbers for different specialties. Don't ding PCPs to favor specialists!

3/8/11 2:27AM View Responses

opportunities for medical students and residents to experience, first hand, practice of medicine and quality of life in rural areas.

3/8/11 2:29AM View Responses

no-fault tort reform

3/8/11 2:32AM View Responses

Reduce the threat from Montpelier to bankrupt all VT physicians.

3/8/11 2:44AM View Responses

encourage primary care teaching/role modeling in rural areas. reduce the payment focus on procedures and volume - figure out a way to pay us based on quality and outcomes.

3/8/11 2:51AM View Responses

Establish Patient Centered Medicl Homes and neighborhoods with adequate capitation to allow more flexible models of care, electronic etc and some fee for service activities. Revalue cognitive rather than procedural care. Reduce payments for procedures.

3/8/11 3:04AM View Responses

Improve reimbursement for all.

3/8/11 3:05AM View Responses

Maximize clinically driven interventions, and clinically driven medical records; reduce barriers to obtaining reimbursement for individualized patient care.

3/8/11 3:29AM View Responses

If single payor results in decreased reimbursement compared to neighboring states, we will lose doctors. I responded no to the question about a public option available to all alongside private due to the current cynical plan to cut Catamount reimbursement, which is a public option, to Medicaid rates.

3/8/11 3:58AM View Responses

Malpractice costs, Hospital support for EMR, Better health system integration

3/8/11 4:01AM View Responses

the political system is totally out of touch with the real world of people and those of us in medicine; how do we cure "political dyfuntional disease?" You will not get much done in Vt. until you fix its politicians

3/8/11 4:23AM View Responses

Increase state subsidization of the medical school to reduce tuition debt of the students, therefore increasing interest in primary care and willingness to stay in the state, 2nd but most important is that we are one of the most taxed states in the nation , Reduce overall tax burden on residents, consolidate school districts and reduce culture of local rule that costs more than a state run or county run system throughout all of government. Reduce entitlements to Vermont residents and thereby reduce tax burden. (A state of 620,000 people over 9200 sq miles cannot deliver an equally distributed set of benefits to its residents and rely on only 200,000 of them to pay taxes. If taxes increase it will rely on only 100,000 stupid ones because the other 100,000 will be smart enough to leave. )

3/8/11 5:44AM View Responses

Increase access to psychiatrists.

3/8/11 7:28AM View Responses

Single payer healthcare system

3/8/11 9:04AM View Responses

a critical mass of rural practitioners so that call is reasonable. I think that could be achieved slowly by #'s 1 and 2 above

3/8/11 8:20PM View Responses

Offer incentives to pre-medicine college students, medical students, and resident physicians to practice in VT. Extend this beyond loan repayment, perhaps something similar to incentives which exist through the armed services, where the Navy, for example, pays a portion of tuition and fees in exchange for a contractual obligation to practice in the Navy for several years after graduation.

3/8/11 9:56PM View Responses

I am double boarded but no longer practice in primary care. There is too much competition from too many other sectors: therapists, NP, PA--and not enough income!

3/8/11 11:03PM View Responses

Decrease taxes.

3/9/11 12:20AM View Responses

Reduce workload. Increase time with patients

3/9/11 12:33AM View Responses

less patients on medicaid or increase reimbursement for medicaid

3/9/11 1:15AM View Responses

Current skewed reimbursement system favoring procedures over office-visits

3/9/11 2:02AM View Responses

Tort reform so we stop wasting SO MUCH money on defensive medicine esp for MCAID population!

3/9/11 2:56AM View Responses

Decrease patient work load in order to focus on fewer patient and increase the quality of care they receive without negatively impacting reimbursements.

3/9/11 3:27AM View Responses

Stop making them compete on uneven terms with FQHC's and other government programs.

3/9/11 4:27AM View Responses

Psychiatrists should be counted as primary physicians for these purposes, given that the shortage of psychiatrists places disproportionate burdens on primary physicians to provide psychiatric care.

3/9/11 6:15AM View Responses

1.)obtaining prior authorizations in order to cater to insurance company economic medicine takes more time and effort than billing for claims, and is KILLING MY PRACTICE 2.) Get rid of the intrusive BC/BS HEDIS surveys. Replace them with NCQA physician certification if necessary; I want to spend my time taking care of patients not insurance companies 3.) Read Groopman's op Ed piece in the Wall Street Journal on the utility (or lack thereof) of electronic medical records

3/9/11 9:51AM View Responses

Reduce the number of people on entitlement programs instead of encouraging them. ( By the way, I grew up on Medicaid, but it has become abused extensively.)

3/9/11 7:39PM View Responses

If a true free market system were allowed to operate, supply would meet demand better than any other system we have or could come up with.

3/9/11 8:31PM View Responses

need to ensure that all emr are the same for all providers and ensure financial ability of physician practices to afford such systems. for ideal system please refer to France's card vitale.

3/9/11 8:44PM View Responses

DO NOT institute the provider revenue tax. This is a net looser for all Vt. Primary care providers. A previous statement was misleading. A 5.5% tax on all patients would not be offset by a 10% increase in payments to the smaller (10-15%) subset of Medicaid patients. This is a sure way to kill primary care in Vermont. Don't forget, recruiting primary care physicians begins before medical school-when kids dream of becoming a doctor. Vt. has to make this environment acceptable to practicing physicians for a decade before this message resonates with prospective recruits. Right now, independant (non-hospital associated) primary care physicians are fronting the costs associated with an EMR, and as yet, no reimbursement has been received from the feds or state. I support the single payer system, but not if it puts my practice out of business.

3/9/11 9:18PM View Responses

get state and federal govt off our backs in every way e.g. radiography, death certifs, Rx requirements etc

3/9/11 9:41PM View Responses

LESS government involvement in medicine - less taxes, less regulations, less, less, less. STOP MEDDLING in an industry you don't understand!

3/9/11 9:49PM View Responses

I think the last 3 are not important at all

3/9/11 11:09PM View Responses

Reimbursement, reimbursement, reimbursement (they've been underpaid for years). Reduce the "hassle factors."

3/10/11 12:39AM View Responses

there is only so much money to be distributed. I think a cut for certain procedures and subspecialist reimbursement is in order to increase reimbursement to primary care docs.

3/10/11 12:55AM View Responses

improve medicaid reimbursement rates which a single payer system is not likely to do in my opinion., A provider tax in an already highly taxed state, just puts any increase in Medicaid rates as a wash especially since I'm 50% medicaid now

3/10/11 2:33AM View Responses

remove prior auth requirements for meds and xrays

3/10/11 2:33AM View Responses

call coverage

3/10/11 3:03AM View Responses

How primary care has gotten into the current situation is not unique in VT. It has to do with long-term trends in defining-downward what their role is in delivering care---currently APRNs are demanding that they can be equivalent. This is grossly untrue but unless MDs can be more pro-active in defining their worth in the medical hierarchy, they will be reduced to fighting rear-guard turf wars that diminish their stature in the public's eye.

3/10/11 3:15AM View Responses

not pass laws that make some PCP's more likely to leave the state over moral/ethical concerns; thanks for doing this survey Dr. Till, please contact me anytime! ~Rachel DiSanto

3/10/11 6:04AM View Responses

We have had sucess in Central Vermont because we raised pay, have great support of the providers, and have a great, collegial working relationship with our hospital and its administrators-

3/10/11 6:34AM View Responses

Develop group practices to improve life style and maintain access.

3/10/11 8:59AM View Responses

SInce I am out 25 years, I rated loan re[ayment lower. It's not just increasing reimbursement. It's how high I have to jump. I can get pay for performance: 1% extra on Medicare: for me I have to pay a $199 fee to register on line and then spend about 4 hours entering data to get back $1000. Or Icouldspend those 4 hours seeing patients, get a little less money, but probably be more helpful to the world in general.

3/10/11 9:33PM View Responses

It's all about the money

3/10/11 10:34PM View Responses

More support in offices

3/11/11 12:19AM View Responses

Improve greater protection against lawsuits

3/11/11 12:25AM View Responses

make the VT Board of Medicine faster, more efficient, more reponsive, and get rid of their face to face interview requirement.

3/11/11 4:30AM View Responses

Change how their after hours call responsibilities are handled so they can live a partially normal life after leaving the office for the day.

3/11/11 8:31AM View Responses

One major issue is assisting spouses of physicans to find jobs/careers. There is very little options for professional couples.

3/11/11 8:59PM View Responses

We need with the above measures to encourage more primary care physicians to come to the area to reduce on call time / patient loads.

3/11/11 10:09PM View Responses

Currently, loan reimbursement is restricted to PCPs who live in VT, not just practice in VT, thereby discouraging practitioners who live near VT from practicing here. This should be remedied.

3/12/11 1:13AM View Responses

TORT REFORM!!!!!!!!!

3/12/11 3:59AM View Responses

There are 3- yes only 3 board certified neurologists with special mcompetence in child neurology this state. My reimbursement is so poor that the plumber, electrician, mechanic and a skilled carpenter do better. Board certified in pediatrics, neurology and child neurology - I left my practice in Vermont last month to concentrate in Mass. where my earnings can support my expenses.

3/12/11 10:57PM View Responses

Support an effort to use Problem Knowledge Couplers at FAHC and in primary care offices

3/12/11 11:03PM View Responses

Train more physicians and don't expect that all physicians will work full time for their entire career. Younger physicians value quality of life more than the older generations. If some of the taxes collected on sugary foods, candy and cigarettes could be used to support an additional residency position in the UVM primary care training programs (Family Medicine, Pediatrics, Psychiatry, & perhaps OB/GYN) and attach some requirement that the subsidized-position graduate has an obligation to practice in VT for some period of time, we might provide a better care for patients & work-satisfaction doctors. By the way, please note that some of the questions on the survey would have been better answered if the question allowed a "I don't know" or "Not enough information/knowlege of the subject to answer" rather than just "Neutral" Thank you for your work on this very important matter, and your willingness to seek input from fellow physicians!!!

3/13/11 5:23AM View Responses

Pay primary call docs for what they do!! Prior Auths, phone calls, on call time, social work, calls from schools, social service agencies, pharmacies, coordination of care, etc........ How about a cut to the elementary Ed budget it consumes more than a third of the budget, in excess of 1.53 billion dollars. I don't hear anybody touching this sacred cow.

3/14/11 5:55AM View Responses

networking among rural MDs and hospitals, improve declining reimburemtns,

3/14/11 7:24AM View Responses

High cost of living in Vermont

3/14/11 1:18PM View Responses

compensation

3/15/11 12:50AM View Responses

Loan repayment programs should include practice loan repayments, not just school loans. Perhaps low interest loans for capital expenses, such as EHR or office fit-up? Like every other business, the cost of health insurance is onerous for small practices. We need a different, not-employer-based mechanism of paying for care for everyone. Lower cost CME, certification, and licensure would help. Why is it so expensive for MDs/DOs to get CME and certification/recertification/licensure in comparison to nurses, pharmacists, PTs, etc??? Worker's Comp should just be rolled into mandatory health care for all. Not getting paid for a medical visit for a WRI because the notes mention a problem not specific to the exact area of injury is plain stupid. We are dealing with people, not account books. They are not parts to be isolated from all other organs and regions of their bodies. Work with INS/Homeland security for more streamlined way to allow FMGs to settle and practice might help increase primary care docs who might not otherwise settle here because of bureaucratic difficulties in getting permission to work in US or getting residency training.

3/15/11 8:31AM View Responses

Call reponsibility and reinbursement for telephone consultations after hours

3/16/11 2:49AM View Responses

My income is already down 30% compared to 4 years ago. I made $140,000 as a full time, private practice Ob/GYN last year. I am considering leaving the state for this reason. I owe $130,000 for medical school loans (down from $185,000 on completion of residency 8 years ago.) Changing to a single payer would put me out of business; also, I doubt that I would be able to sell the medical office space I purchased two years ago. I am truly concerned that I would end up bankrupt.

3/17/11 3:22AM View Responses

Hire more nurse practitioners

3/17/11 4:32AM View Responses

I am a PA practicing for 18 yrs at the same rural site. I believe the nonphysicians are the key to increasing and improving care in Vt. I taks care of my own patients, cradle to grave who are rarely if ever seen by the docs in my practice,Physicians are not the only or the best answer.

3/17/11 6:14AM View Responses

not only increase payment to primary care physicians but decrease reimbursement to specialists.

3/17/11 8:57AM View Responses

Improve Medicaid reimbursement - let the state pay for what physicians are now doing before adding on more and more demands and taxing us on what little we now make taking care of the most needy!!

3/17/11 10:12AM View Responses

We must be paid for preventative medical care.

3/17/11 7:47PM View Responses

Incentives for medical schools

3/17/11 8:23PM View Responses

I am a specialist and can't speak for the primary care docs

3/17/11 10:29PM View Responses

Improve job satisfaction for PCPs by recognizing their key role in the health care system and providing appropriate patient support.

3/18/11 1:38AM View Responses

Uncertain

3/18/11 1:40AM View Responses

Supports for medical home activities-- for rural families-- with transportation-- socioeconomic challenges

3/18/11 1:43AM View Responses

Preserve and protect the medical school and the academic health center

3/18/11 1:43AM View Responses

The absolute income is not as important as the relative income compared to specialists. Perhaps the income of the latter could come down!

3/18/11 1:44AM View Responses

respect

3/18/11 1:45AM View Responses

Reduce the cost of medical education. As a UVM faculty member, I am embarrassed by the huge amount we charge for tuition. The sizable loans that so many docs incur during med school undoubtedly influence the decisions they make regarding specialties.

3/18/11 1:47AM View Responses

We have PLENTY of primary caregivers here. Among the highest percentage in the country...

3/18/11 1:51AM View Responses

pay for telephone calls and care coordination

3/18/11 2:09AM View Responses

Increasing the number of PAs and NPs who do primary care will alleviate the load on PCPs

3/18/11 2:16AM View Responses

incentives in training programs - loan repayment is important

3/18/11 2:24AM View Responses

heavy work load, administrative burden, poor compensation, and anti-physician sentiment from the current administration.

3/18/11 2:26AM View Responses

Increase office support

3/18/11 2:43AM View Responses

better assistance with not truely medical issues (psycho-social, environmental) that get dumped on PCPs such as integrated social workers and behavioral health experts (i.e. a medical home model).

3/18/11 2:44AM View Responses

Improve working conditions---being a primary care physician in a rural area with little cross coverage is a daunting, exhausting prospect with little appeal.

3/18/11 2:46AM View Responses

currently the burden of being a primary care physician, far outstrips the reimbursement.

3/18/11 2:56AM View Responses

My answers are a guess. Ask the primary care MD's

3/18/11 3:03AM View Responses

More respect from insurance companies. as a primary care MD I have to get prior autherization for tests, medications or proceedures that do not require PA if done by a specialist.

3/18/11 3:11AM View Responses

Get the government off of our backs!!!!!!!!!!!!!!!!!!!

3/18/11 3:21AM View Responses

Overall infrastructure improvements

3/18/11 3:25AM View Responses

use NP's and PA's to perform the bulk of primary care functions with a single MD available per office to handle more complex cases and be available to consult.

3/18/11 3:40AM View Responses

Simply make reimbursements reasonable to afford them the ability to run a business with reasonable profits (income)

3/18/11 3:42AM View Responses

Free membership to a local golf club!

3/18/11 3:45AM View Responses

Solving the primary care problem is a nationwide issue. But it's not really about primary care. It was ridiculous for policymakers in the first place to think more primary care MDs would solve our country's sociomedical crisis. No MD wants to be overburdened with managing the fallout of this sociomedical crisis-- evidenced by a country increasingly dominated by obese, diabetic, smokers and drug abusers (illicit and prescription) who are irresponsible, disenfranchised and depressed and have been told by politicians and the media that health care is a right and someone else should solve all their problems. All their problems which at one point may have been merely social/behavioral and are now medically realted in some way and therefore the responsibility of the medical system to solve. We have the greatest health care in the world but the worst situation in part because we have the most demanding, spoiled, irresponsible and profoundly unhealthy population in the world. Make people responsible for their health and you solve most of the problem. Give everyone a free ticket and no responsibility for their health and they will eventually rip your face off. And everyone involved in health care should take the Hippocratic Oath not just doctors and be liable for bad decisions if they affect patient care.

3/18/11 3:49AM View Responses

Tuition forgiveness for UVM medicaL SCHOOL GERADUATES WHO COMMIT TO PRIMARY CARE CAREERS.

3/18/11 4:00AM View Responses

Increase pediatric sub-specialists

3/18/11 4:00AM View Responses

Malpractice caps/limitations.

3/18/11 4:04AM View Responses

Having trained out of state, worked there for a while and returned I can tell you that VT physician salaries are among the lowest and the cost of living definitely the highest when compared to any other location that is otherwise desireable to live.

3/18/11 4:09AM View Responses

limit government involvment in medicine and dentistry

3/18/11 4:22AM View Responses

support for practice, secretaries, computers, etc.

3/18/11 4:44AM View Responses

what is meant by shortage? not sure I agree with that statement

3/18/11 4:45AM View Responses

Restructure reimbursement such that preventative medicine is the highest reimbursement

3/18/11 5:04AM View Responses

reduce administrative complexity AND reduce medical liability risk

3/18/11 5:28AM View Responses

The federal government gives 9 billion a year to medical centes yearly for postgraduate physician training of predominantly specialists. That has to change for there to be few specialists trained.

3/18/11 5:32AM View Responses

Physicians are not going to move to Vermont (or stay in Vermont) if they feel the state only wants them here to: A. Fund the taxes, and, B. Provide cheap health care.

3/18/11 5:33AM View Responses

For OB/GYN malpractice reform, not just no-fault insurance. I think no-fault insurance may just increase claims.

3/18/11 5:45AM View Responses

Decreased work load, pts are sicker now than they have been in the past and take much more time and effort to care for them, as decreasing reimbursements increase. We are working harder than ever before and are getting paid less. I (and probably most) will not work any harder and that will create huge access problems. Think it takes a long time to get in to see an MD now, just wait....

3/18/11 6:06AM View Responses

physician extender as answer to question #22

3/18/11 6:07AM View Responses

FAIR compensation for non procedure based medical care

3/18/11 6:22AM View Responses

place primary care at the TOP rung of health care and promote the importance of this to patients, specialists, communities

3/18/11 7:37AM View Responses

leaability

3/18/11 7:39AM View Responses

mostly reimbursement

3/18/11 7:54AM View Responses

decrease insurance reimbursement paperwork

3/18/11 9:11AM View Responses

attract more mid-level providers to primary care independent practice for nurse practitioners and PAs

3/18/11 9:26AM View Responses

Reimbursement partial parity with other speciaties would solve the problem entirely.

3/18/11 9:30AM View Responses

Start a Physician Assistant Program at UVM

3/18/11 9:38AM View Responses

medical legal reform

3/18/11 10:14AM View Responses

Honestly - the main reason I have chosen not to practice primary care in a more rural, high need location in VT is because the isolation and high need in these areas (frequent call, frequent trips to the DR and emergency) would require more work hours than I could balance with a family right now. Daycare options are limited to 9-5 PM - so the limitations of childcare are actually one of the biggest factors that played into my decision to remain in Chittenden county. I think I actually have FABULOUS access to pediatric specialists, but I know my colleagues who need to consult adult specialists feel more limited.

3/18/11 11:40AM View Responses

Have hospitals hire them

3/18/11 11:51AM View Responses

Comprehensive tort reform - I am sure Taiwan does not have contingency fees and jury trials for medical malpractice. Taxing medical practices alone is not fair and equitable - why not tax law practices as well...

3/18/11 6:09PM View Responses

Make income generated by government-paid health insurance NON-TAXABLE by the state.

3/18/11 7:50PM View Responses

Pay levels and exccess paperwork. Regarding the survey questions about single payer- I was not able to answer most of them because they are far to vague in the phrasing. I support most of those initiatives IF they are put through in a sensible manner and fully funded. I really don't want to see a poorly planned single payer system rushed through the system for political purposes. Vermont cannot afford to loose the medical community that it has.

3/18/11 8:01PM View Responses

Most physicians who actually take care of patients would like the simplicity of a single-payer system and believe that ethically everyone should have access. It's important to realize that the opportunity cost of school/traininag is high, so you won't attract smart people if you try to accomplish this by cutting reimbursment to primary care and non-procedural specialists, which is already poor. The way to do it is to limit use of technology to when it's appropriate (i.e., not everyone should be entitled to unlimited MRIs, or a liver transplant, etc.). That's where most of the money is spent and it's often fruitless. Though this may be called rationing, what it really is is common sense.

3/18/11 8:02PM View Responses

restore primary care authority over payment entities and Pharma.

3/18/11 8:03PM View Responses

Targeted recruiting/dedicated recruiter. It's helped a lot in our area.

3/18/11 8:39PM View Responses

Please consider the impact of a provider tax to employed physicians like myself. If my employer does not choose to increase my salary, the 5.5% provider tax will simply be a cut in my salary without compensation.

3/18/11 8:47PM View Responses

?

3/18/11 9:02PM View Responses

Build support teams so that they can take time off, people burn out!

3/18/11 9:32PM View Responses

Lifestyle considerations - coverage so there is adequate time off

3/18/11 9:59PM View Responses

Change focus away from RVUs (how many patients you can see in a day) and toward patient outcomes.

3/18/11 10:30PM View Responses

increased reimbursement is key

3/18/11 10:41PM View Responses

Allow NP and APRN to provide primary care

3/18/11 10:48PM View Responses

Reimbursement

3/18/11 10:58PM View Responses

Tort reform reduce liability

3/18/11 11:20PM View Responses

Improving reimbursement for time spent with patients so that practices can work on quality improvement, chronic health management and prevention. A single payer system is very appealing to primary care physicians like me, and would be improve physician recruitment!

3/18/11 11:34PM View Responses

One single statewide electronic health record used by all providers. The current scramble with every practice searching among multiple low quality private sector software programs--all of which are multiple mutually incompatible -- is unhelpful and a big waste of money

3/18/11 11:39PM View Responses

Not sure. Reimbursement is likely to be important.

3/19/11 3:02AM View Responses

Support for physician originated community programs

3/19/11 3:23AM View Responses

Primary care physicians need to be paid more, this is a major determinant of medical student career pathways

3/19/11 3:30AM View Responses

If there is to be a tax, or cuts, start cutting at the top ie the highest paid folks and let us who have been at the bottom for years alone.

3/19/11 5:13AM View Responses

Good mentors and access to these mentors for students before they even get into medical school.

3/19/11 10:04AM View Responses

We need better EHR's. The one at CVMC is quite good, at least as the CVMC IT staff has implimented it and formatted it. The EHR records from FAHC are terrible. My two greatest frustrations in practice, primary care internal medicine, are having to deal with insurance companies and with the medical records from FAHC, and now I can add eScripts to my list of major frustrations.

3/19/11 10:28AM View Responses

Many primary care physicians do not want to work in isolation. Strengthening regional hubs (perhaps through the CHCs) may help minimize this problem The problem is not just money; its that many PCPs are overworked. The proposed switch to a single payer system could worsen this situation significantly by chasing away some of those who are there now and make it even that much harder to ever replace them. It also seriously threatens the existence of specialists in our state, which for many specialties, are already in short supply. Primary care docs should not be expected to provide for patients without access to specialists.

3/19/11 11:25PM View Responses

Tort Reform

3/20/11 2:09AM View Responses

reimbursement in general, reimbursement for all the phone calls, management, teaching, coordinating care,paperwork, etc that is totally nonreimbursed

3/20/11 9:38AM View Responses

education

3/20/11 11:29PM View Responses

Develop health care systems that employ rural docs and make referrals available without the specialists not being reimbursed. Many referrals that I see could be done by phone or email but the referring providers realize that is not fair to the specialists.

3/20/11 11:38PM View Responses

decrease procedural reimbursements, and increase reimbursement rates for office based primary care claims.

3/21/11 12:13AM View Responses

to much insurance co. interferance with practicing sate and effective primary care

3/21/11 1:52AM View Responses

single payer financing reform

3/21/11 3:30AM View Responses

primary care practices with high medicaid percentages need special protection

3/21/11 4:30AM View Responses

What about increasing reimbursements for nurse practitioners so that MD's will be more likely to recruit them into practice?

3/21/11 9:42AM View Responses

Make it easier for non-physician providers such as PAs to join existing practices or to extend care to more rural areas.

3/21/11 8:56PM View Responses

More support from psychiatric providers and those managing chronic pain and those managing addiction treatment

3/21/11 9:01PM View Responses

Designate more practices as community health centers to increase reimbursement rates and reduce costs.

3/21/11 9:40PM View Responses

DECREASE MEDICAL LIABILITY INSURANCE

3/21/11 10:08PM View Responses

Ask a primamry care MD. These are guesses on my part

3/22/11 12:27AM View Responses

prior approvals are extremely frustrating and vary with each company.

3/22/11 1:06AM View Responses

1. Promote a wider delivery of medical services by primary care doctors safely using a partnership of specialty boards and primary care boards.( i.e. Australia's rural doctor medical license) 2. Promote rational health care decisions despite entrenched hospital or specialty interests. (see Dr. Wennberg's work with the Dartmouth Health Atlas)

3/22/11 3:09AM View Responses

decrease payments to hospitals for procedures and increase E and M nonprocedure based reimbursement

3/22/11 5:18AM View Responses

Need to use all providers of primary care ie nurse practitioners. Inclusive language needed. Independence.

3/22/11 5:33AM View Responses

Tort reform and increased patient role and responsibility in the medical care decision process which will impact cost control by the patient.

3/22/11 6:36AM View Responses

malpractice reform

3/23/11 2:09AM View Responses

Don't create an additional income tax on physicians

3/23/11 5:05AM View Responses

The above issues are the major ones.

3/23/11 5:38AM View Responses

single payor or single insurance billing system would help a lot i think. Also help with networking with specialists.

3/23/11 6:09PM View Responses

Decreasing the payment gap between specialists

3/24/11 1:09AM View Responses

Fair compensation for my time compared to "specialists" My recent hand xray paid the radiologist $196 just to read it! They can read 15-20 an hour. Why is the time I spend with direct patient care reimbursed so poorly? I think specialists are grossly overpaid for their time and should reduce that in favor of primary care increased compensation, then you would attract more.

3/24/11 9:08PM View Responses

mental health - for families - since PCPs are over-burdened by problems that really require counselling by a therapist

3/25/11 4:50AM View Responses

State must support the medical school to take more in-state students, and should offer better loan-repayment programs for physicians to work in underserved areas.

3/25/11 5:22AM View Responses

Maintain personal respsonsibility of primary md's for care of multiple complex medical illnesses through both inpatient and outpatient setting. Get rid of the idea that checklists and EMR's are as helpful as they are billed. Legislate the need for all EMR's to talk to each other and fund that "B-to-B" software necessary to make this happen.

3/25/11 7:26PM View Responses

PCP's to be able to care for their own in-pts. and not only by Hospitalists

3/27/11 5:42AM View Responses

Assistance with recruitment! If other docs just knew how great it is to work here, they would come (I think!). Assistance with after hour phone service. Taking second call only is much more attractive!

3/27/11 8:38AM View Responses

Community resources for patients

3/28/11 4:19AM View Responses

You have to pay them a "living wage" and one that allows them to repay their crushing student loans. We also have trouble recruitng specialists, and if we get a single payer system it will be much worse recruiting. There is only lip serevice being paid to quality of care under this proposal. Wait until the public realize what they have lost with the single payer system.

3/29/11 7:52AM View Responses

Malpractice reform. I worked in a single-payer system (in New Zealand) and it worked great, in part due to the much lower costs to the system since lawyers were not involved. The care there is actually monitored much more closely than in the US and bad docs are weeded out by the medical system. As a consequence we did not practice defensive medicine, which in my humble opinion is MUCH more than estimated. I would be happy to discuss my NZ perspective with anyone interested -- Richard Burgoyne, CVMC

3/31/11 12:38AM View Responses

malpractice caps

4/1/11 12:48AM