1. The Future of Primary Healthcare Presented by Barbara Marx Brocato Barbara Marx Brocato& Associates 18 Pinkney Street Annapolis, MD 21401 Phone: 410-269-1503 Fax: 410-269-5021 E-mail: Barbara@bmbassoc.comBarbara@bmbassoc.com Web Site: www.bmbassoc.comwww.bmbassoc.com

2. The Health Care Debate Increased insurance coverage and increased eligibility DOES NOT equal increased access to care You need an ample provider workforce Maryland physician workforce is threatened

3. Governor’s Task Force on Health Care Access and Reimbursement 2007-2008

4. Table 3. Average Income for Selected Specialties in the United States Annual IncomeIncome Relative to Radiation Oncologist’s Income Radiation Oncology$489,765100% Orthopedic Surgery$476,78197% Diagnostic Radiology$449,66492% Plastic Surgery$408,06583% Dermatology$390,27480% Anesthesiology$371,06676% Otolaryngology$369,15475% General Surgery$330,21567% OB/GYN$296,39961% Emergency Medicine$258,08853% Neurology$254,55852% Internal Medicine$191,52639% Pediatrics$188,49638% Family Practice$178,82937% Source: Medical Group Management Association (MGMA). Physician Compensation and Production Survey: 2007 Report, based on 2006 data as published in the New York Times; accessed at http://www.nytimes.com/2008/03/19/fashion/19beauty.html?_r=2&scp=1&sq=the+price+of+beauty&st=nyt; Maryland- specific results are not available due to small cell sizes. From the December 2008 Report of the Task Force on Health Care Access and Reimbursement Established under Senate Bill 107

5. Commercial reimbursement in Maryland is in the lowest 25% of the country Medicare and Medicaid provide very low reimbursement Maryland is a high cost of living state Physician recruitment happens in a National market States with more favorable systems have an advantage over Maryland The Health Care Environment

6. Increasingly those “going down the road” to medicine are not going into primary care Results in a shortage of primary care physicians  Leads to increased utilization of emergency departments and long wait times to be treated Providers not accepting Medicare Establishing concierge practices – patient pays an annual or monthly fee for physician to provide services. This is not a substitute for insurance, some concierge practices do not accept insurance. The Health Care Environment

7. Health Care Reform Where will the solutions come from(?)  Federal?  State?  Combination of both? What are some possible approaches?  Fairer provider reimbursement  Incentives to attract primary care physicians  Loan forgiveness  Tort Reform  Bundled Payments  Medical Homes  Case management systems

8. Barbara Marx Brocato & Associates For a copy of this presentation contact us at: 18 Pinkney Street Annapolis, MD 21401 Phone: 410-269-1503 Fax: 410-269-5021 E-mail: Barbara@bmbassoc.comBarbara@bmbassoc.com Web Site: www.bmbassoc.comwww.bmbassoc.com