Earl Berman, MD
Potential Conflicts of Interest: None disclosed.
Berman E.; Teaching Health Centers and the Primary Care Workforce Crisis for the Underserved. Ann Intern Med. 2010;152:614. doi: 10.7326/0003-4819-152-9-201005040-00014
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Published: Ann Intern Med. 2010;152(9):614.
TO THE EDITOR:
One of the proposed models for national health care is to expand into the natural adjacency of the Medicare and Medicaid systems. However, the influx of new patients will cause an even greater burden on a failing system, and the current workforce of physicians and nonphysician providers will be unable to properly care for these patients. The model proposed by Rieselbach and colleagues (1) seems viable and operationally sound, but the funding mechanism remains a challenge.
A plausible funding mechanism would be to allocate a portion of recoveries from the Recovery Audit Contractor (RAC) program to this primary care initiative. Although it is operationally impractical to prevent all improper payments, a January 2008 report by the Office of Management and Budget (2) indicated that Medicare is among the top 3 federal programs with improper payments (not fraud), with an estimated total of $10.8 billion in 2007 (2). The Centers for Medicare & Medicaid Services performed a 3-year pilot RAC program in 3 states. The RACs corrected more than $1.03 billion in improper Medicare payments (2). Conservative estimates suggest that the recoveries from the mature program will exceed $35 billion per year.
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