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Health care cliff: The effort to reduce ER visits and find primary care doctors

To draw people away from the specialties and into primary care - which doesn't pay as much - Quinnipiac is offering fellowships to students. (AP Photo/File)

With the major provisions of health care reform about to kick in, hospitals are trying to deal with the big unsolved issue – rising costs. One hospital discovered that it could save a lot of money – just by providing a little help to confused patients.

“Oh God, it must be nine or ten medicines,” says Marjorie Crear. “It’s hard to keep track!”

Sometimes, dealing with a hospital is like trying to find your way around a strange city without a map … at night … while naked and in pain.

Take the case of 66-year-old Crear. She has back pain, diabetes, and hypertension, and last year went to the emergency room eight times.

“I went more than I wanted to go, but I had no choice,” explains Crear.

But under health care reform, when a hospital discharges a Medicare patient, and that patient comes back in 30 days, the hospital gets dinged for a penalty. So UCLA Medical Center and other hospitals are trying something new. They’re hiring “Care Coordinators” to supervise patients after they leave the hospital.

Care coordinator Tiffany Phan was assigned to Marjorie Crear and her job was to check up on Marjorie, to make sure she took the right medications at the right times.

“As I was doing that over the weeks, her blood pressure decreased, her blood sugars came down, she remembered to take medications,” says Phan.

And just as important, Majorie no longer had the feeling of being alone and ignored. Now she had a friend who understood what she was going through, could help if she had a problem, and who cared. “I know eventually she’s going to call and I’m not just going to lay here and die.”

As for the dollars and cents part of the story – in the six months since Marjorie’s Care Coordinator has been on the job, her emergency room visits have totaled ZERO.

Of course then there’s the other problem — training enough doctors for the 30 million Americans who will be insured for the first time under health care reform.
That could bring the country up to the edge of its latest cliff.

“You’ve heard about the fiscal cliff, I think we’re on the verge of a health care cliff,” says Dr. Bruce Koeppen.

One-third of all the doctors in the U.S. plan to hang it up in the next ten years, “That’s almost a quarter of a million physicians that will leave the workforce.”
Koeppen is the founding Dean of the new medical school at Quinnipiac University. He takes over at a time when retirements are expected to lead to a shortage of about 130,000 doctors by the year 2025.

Since the worst shortage is expected to be in primary care, the doctors who most people to to first when they’re sick, that’s what Quinnipiac’s medical school intends to focus on.

To draw people away from the specialties and into primary care – which doesn’t pay as much – Quinnipiac is offering fellowships to students like Timothy O’Rourke who says he’s more than happy to work where the greatest need is.

“We need to take into consideration the country as a whole and the huge gap that there will be in primary care specifically,” says O’Rourke.

Fortunately for aging baby boomers, a lot of medical students feel the same way Tim does – Quinnipiac received 2,000 applications for its first class.

Unfortunately it has exactly 60 slots.

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