HCA and Primary Care just do not fit

Written by Dr. Rachel Hines

Source: Asheville Citizen-Times, Sunday 18 October 2020

I appreciated Ms. Wicker’s article “Mission Health: What Has Changed Under HCA and Why.” As a local family physician, we hear stories of heroic and timely care as well as staff overwhelm, high cost, and poor access. Unfortunately, the closing of primary care offices in Biltmore Park and Candler was not surprising.

Hospitals are where our sickest kin go (with the exception of some on Labor and Delivery). In contrast, strong primary care prevents people from getting sick or at least prevents existing medical conditions from progressing to the point of needing hospitalization. When primary care is undermined, especially in safety net clinics, people will get sicker and end up utilizing specialty, urgent, and emergent care more often. With any for-profit hospital corporation at the helm, this ultimately boosts the bottom line at the expense of individuals’ health, not to mention the rising costs of care. This is not unique to for-profit health systems but it is a more exaggerated one. Primary care has been steadily consolidating under systems – like Novant, Vidant, UNC, Duke, and Atrium to name a few just in our state. There are many reasons for this including federal legislation spanning multiple presidencies.

None of this has to be a given. It is not a given that so many people must get sick enough to go to the hospital. Many acute illnesses can be prevented by a combination of counseling, medicine, lifestyle, and, ironically, avoiding the hospital itself – medical errors in hospitals are consistently a leading cause of death in the US. It is also not a given that doctors must be disincentivized to accept Medicaid and Medicare insurance, as Ms. Wicker alludes to in the article. It is not a given that the practice of primary care must be reduced to writing prescriptions or referrals in a 10 minute visit. It will take advocacy, innovation, and legislation to put us on a new path.

The story of my own practice, Lantern Health (formerly Avenu Health) was nearly another cautionary tale. Founded by Mission in 2017 as the system’s “Innovation Clinic,” its goal was to transform and strengthen the practice of primary care. Our care delivery was ultimately modeled as full-scope Direct Primary Care (DPC). In short, a financial model based on a monthly fee instead of fee-for-service translates into simplicity, transparent pricing, access to physicians through the full range of virtual and asynchronous options (texting, phone, video), and more time with providers, nurses, and health coaches. These are measures that routinely prevent chronic conditions, prevent worsening illness, prevent the need for hospital care, and save money. Mission recognized the need to re-center its own primary care services in a flailing system and was trying to do something about it.

HCA had an opportunity to continue this effort but chose not to. In February of 2020, Avenu Health was divested from HCA. Thankfully, my physician partner purchased our practice and as Lantern Health, we have continued to grow and deliver high-value primary care alongside several other local DPC practices. Now, in a fit of irony, we see that HCA touts a $25 million innovation grant aimed at investing “in local companies working to improve the quality, cost or efficiency of healthcare in the region.” This while they have removed quality incentives and focused entirely on volume (i.e. profit) as the priority for providers in HCA practices. As a citizen of the community, I want our local hospitals to exist and thrive for unpreventable emergencies and specialized treatments. I am unconvinced, however, that a for-profit hospital-based system can choose the right priorities – even when it was handed to them by their predecessor. I hope HCA proves me wrong but I’m not holding my breath.

Instead, I will go into work today, spend an hour with new patients, offer health coaching or mindfulness therapy, discuss nutrition goals, recommend supplements or medicines, and dig into the root causes of problems. People will call or text us – during or after hours instead of going to the ER or missing work. Innovation is happening. Primary care is available in Asheville. It just cannot and should not look the same as it has in recent memory.

And if you are getting primary care as it’s meant to be – keeping you as far from the hospital as possible – the office will not have HCA’s name on the door.

Dr. Rachel Hines is a Family Medicine physician who lives and practices in Asheville, NC. Her practice, Lantern Health, is a direct primary care practice that serves individuals of all ages, families, and small businesses in Asheville.

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