Primary Care

Harold Cramer wants to make one thing perfectly clear: His new friends from the West won't bring California-style health care to the Philadelphia-area market. The chief executive of Graduate Health System Inc. is on a mission to dispel an image of Health Systems International Inc. as a no-frills, bottom- line deliverer of medicine. The managed-health-care company, which has headquarters in Pueblo, Colo., and Woodland Hills, Calif., recently said it would spend $112.5 million to buy Greater Atlantic Health Service Inc. - among other businesses - and to run Graduate's seven local nonprofit hospitals.

Gov. Casey outlined a long-range initiative yesterday to attract more primary-care physicians and dentists to Pennsylvania's inner cities and rural communities. Presented by the administration as a major new initiative, the program provides $6 million in state and federal dollars over two years, and its cornerstone was enacted into law in December along with a measure to provide health insurance to lower-income children. Dubbed "Securing a Healthy Pennsylvania: Laying the Foundation," the initiative proposes funding for several new programs aimed at getting high school students interested in family medicine and providing support services for physicians and dentists practicing in underserved areas.

The new Karabots Pediatric Care Center in West Philadelphia, with 35 doctors, is by far the biggest primary-care office in the Children's Hospital of Philadelphia network. But the $27 million facility at 48th and Market Streets, named for Nicholas and Athena Karabots, who contributed $7.5 million toward the project, aims to be much more than a doctor's office with 56 examination rooms. The Karabots Center opened in phases last month, combining three West Philadelphia sites. The official ribbon-cutting is scheduled for Wednesday.

The United States has a shortage of primary-care physicians. This limits the options for improving access to cost-effective health care. Nurses are a national resource with the potential to meet this challenge. Since the late 1960s, federal policy has promoted two strategies to increase primary care. The first included federal support for establishing a new physician specialty in family practice. It has not yet been successful. Between 1970 and 1990, the proportion of doctors in primary-care actually declined and the rate of decline is accelerating.

Nine primary care physicians' practices in South Jersey are participating in an initiative that will pay them an average of $20 month per Medicare fee-for-service beneficiary to support enhanced, coordinated services, the federal government's Center for Medicare and Medicaid Innovation said. The goal is to improve quality and reduce costs. Overall, 73 primary care locations in New Jersey were selected to participate in the program, which is being launched this fall in seven regions around the country.

When Dr. Keith Sweigard opened his general practice 12 years ago, he never dreamed that someday he would give up his autonomy and become a hospital employee. But that's exactly what Sweigard did during the summer, when he sold what had grown into a seven-person partnership to Abington Memorial Hospital. "The times have changed," the internist said. And then some. Arrangements such as the one between Sweigard and Abington Memorial have been repeated hundreds of times throughout the region.

JOHN Baer's June 9 column endorses a concept known as rate collapsing, wherein all physicians would pay the same medical liability insurance rate. There is no saving in rate collapsing. It's a cost-shifting scheme that does not solve the problem. Worse, it would further endanger Pennsylvanians' access to primary care by forcing more family doctors out of state and out of practice. For purposes of setting rates, 151 specialties types are merged into 13 classifications. Rate collapsing would fuse those 13 into just one. Physician classifications are already collapsed.

As the newly elected president of the Pennsylvania Academy of Family Physicians, I will spend much of the next year advocating for health-care reform on the state and national levels. I will be arguing that less can sometimes mean more: Less testing, fewer lawsuits, and fewer visits to specialists can mean a healthier public and more affordable, sustainable health care. Universal health insurance can be a step toward reform, but it is not the answer to all our woes. The more than 4,000 family physicians across the commonwealth are one small but important piece of the enormous puzzle.

Jeff Cuomo went to Hahnemann University knowing exactly what kind of doctor he wants to be: one of those high-priced specialists that have fallen out of favor lately. A sports enthusiast who has had four knee operations, Cuomo wants to be an orthopedic surgeon. Not for the money, he says. For the satisfaction. Cuomo likes a job that you can finish, a problem you can fix. That's why he's more comfortable with surgery than primary care. In primary care, the patients come in with chronic problems that never seem to get much better.

The University of Pennsylvania Health System and Germantown Medical Center are teaming up to form a new health network. Spokesmen for the nonprofit medical groups yesterday announced a "formal affiliation agreement" to share services and improve education, research and patient care. The affiliation, which is effective immediately, is not a merger or acquisition. No money is being exchanged. And the two organizations will continue to govern their own affairs. Penn officials described the agreement as "the first step" in creating a network of community hospitals, doctors' groups and other medical providers throughout the region, with Penn's $700 million health-care system serving as the anchor.