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    1 Comment for this article
    EXPAND ALL
    Improving population health and its health care, altogether
    Paul Nelson, MS, MD | Family Health Care, P.C. retired
    Given the current evolution of micro-reform projects as the strategy to release the paradigm paralysis afflicting our nation's population health and its health care, this Research Letter from Doctors Hsiang et al signals the futility of any national strategy to assure that Primary Healthcare is equitably available and ethnographically accessible, within every community, to each of its resident persons. Given that excess health spending during 2019 may have been $1 Trillion, any plan to apply new funding strategies for Primary Healthcare would be DOA. I am assuming that health spending in 2019 was 18% of the GDP and that our health spending could be 13% given that all of the other developed nation's (OECD) allocate 12% or less of their economies to health spending.

    In the midst of the drudgery related to the pandemic, we best think about Population HEALTH and its needs as separate from, but related to, standard healthcare reform. Does anyone seriously believe that the healthcare industry should be tasked with resolving our nation's declining Social Cohesion and its related Social Capital? Assuming that the SDOH affecting each person's Well-Being involves locally unique cultural and ecologic traditions, it is very likely that locally constituted collaborative response teams will be required to assemble the social networks necessary to prevent, mitigate, and ameliorate the social mobility and social isolation issues within their own community.

    Maternal mortality, childhood ACEs, pre-adolescent obesity, adolescent suffering, homelessness, mass shootings, substance abuse, mid-life preventable deaths/disability, and annual stagnant longevity at birth since 2010 - ALL await our nation's recognition of its fundamental inaction. How much are we really committed to the importance of Primary Healthcare?

    Maya Angelou said it best: "What I have learned is that people will forget what you said, people will forget what you did, but people will never forget how you made them feel."
    CONFLICT OF INTEREST: None Reported
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    Research Letter
    Health Policy
    July 28, 2020

    Trends in Compensation for Primary Care and Specialist Physicians After Implementation of the Affordable Care Act

    Author Affiliations
    • 1Yale School of Medicine, Yale University, New Haven, Connecticut
    • 2Yale School of Management, Yale University, New Haven, Connecticut
    • 3Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
    • 4Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, Yale University, New Haven, Connecticut
    • 5MD Anderson Cancer Center, Houston, Texas
    • 6Department of Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut
    • 7Yale School of Public Health, Yale University, New Haven, Connecticut
    JAMA Netw Open. 2020;3(7):e2011981. doi:10.1001/jamanetworkopen.2020.11981

    When the Affordable Care Act (ACA) was passed, physicians were unsure how their salaries would be affected. Since the implementation of the ACA, numerous factors may have affected physician compensation, including increased emphasis on alternative payment models and discounted insurance payments from health exchanges. The ACA also included 2 temporary fee increases specifically for primary care physicians (PCPs): the 2013-2014 “Medicaid fee bump” and the 2011-2015 Primary Care Incentive Program.1 Given these factors and the 10th anniversary of the ACA, we sought to answer the following 2 concerns: (1) how overall physician compensation has changed and (2) how PCP compensation has changed relative to specialist compensation since the ACA was passed.

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