re: Primary healthcare services crisis - how does Obamacare address it?

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Since Medicare sets low reimbursement rates for regular office visits to primary care physicians, do major health insurance companies follow their lead in negotiating reimbursement rates?

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CMS has increased PCP reibmursement as a part of Obamacare, but that increase has been immediately nullified by federal "incentives" that require significant capital outlay to implement them. EMR implementation, meaningful use, PQRS reporting, etc... all cost a shite ton of money and human capital, and offices with 3 or less physicians don't have the economies of scale to pull them off. So they are hit with a 1% reduction in CMS reimbursement for each incentive they can't meet...and there goes the increased reimbursement.

Private payers do follow CMS with regard to pricing, usually + 3%-8%.

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Is there a solution to this problem?

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More residency opportunities for primary care? Better tuition reimbursement programs for med students who go into primary care? Redesign some of the EMR incentive programs to accomodate small practices? Increas reimbursement for consult and f/u codes for PCPs?

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How does Obamacare address the primary healthcare services crisis that many parts of this country has experienced over the past couple of decades?

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Pilot payment systems based on quality (won't work) and slightly increase reimbursement for PCP's.

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Would real medical care reform be complete without addressing primary health care services? How would Washington go about encouraging more medical professionals to enter primary care specialties? Is that even possible?

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Yes, primary care would need a revamp for any successfull healthcare "redesign", but we seem to just be headed for primary care provided by mid-levels with minimal phsyicians supervision.

Which personally, I'm fine with, but I'm a 35 year old healthy person with connections to many medical specialties and a PA for a wife.

I'm not sure the 68 year old diabetic with COPD and an abnormal liver panel wants his treatment from a NP or PA.


ETA: Medicaid is also a HUGE problem for PCP's. MCD reimbursement does not cover the cost of providing care, forcing docs that see mostly MCD patients to herd them through clinic as fast as possible in order to simply break even. Obamacare has only made this problem much worse by adding so many uninsured to MCD rolls. Particularly when most PCP's won't even take it at this point if they don't have to.