Comprehensive primary care reduces costs, organizing for better care, and change culture to improve patient safety

May 14th, 2015

May 14, 2015

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

Join the conversation: Post your comments in our new section at the bottom of this page.



This week, Anders Kelto in an NPR segment, reports on a study from the Annals of Family Medicine, which found that family physicians who provide comprehensive care to their patients are reducing costs. The researchers looked at data from more than half a million Medicare patients, and learned that patients of physicians who provided more care were 35 percent less likely to be hospitalized, compared with patients of physicians who provided minimal comprehensive care. Costs were reduced by as much as 15 percent. One of the study’s authors, Robert Phillips, MD, believes that Medicare costs have been rising steadily, partly because of the increased use of specialists; presently, 80 percent of physicians in the nation are specialists, according to the American Academy of Family Physicians. In a commentary augmenting the AFM piece, Kevin Grumbach, MD, opines: “Fostering comprehensive primary care will not simply be achieved by promoting a broad scope of training during residency education, but by ensuring that physician payment policies fairly compensate family physicians and their practice teams who invest the time and effort to provide the type of holistic care that brings value to patients and the health system.”


Three articles this week emphasized the importance of collective action to improve healthcare. In JAMA, Scott I. Berman, MD argues that physicians must stop “whining” about interference in medicine from hospital administrators, insurers, and the like, and take a stand for getting patients the right care. Pritpal S. Tamber, MBChB suggests that patients and communities ought to take control of the medical system, particularly by expanding our conception of health beyond the biomedical model to include a variety of aspects of community life. He notes that while the medical system will remain expert in the diagnosis and treatment of illnesses, communities must be recognized as experts in the implications of policy decisions for their lives and health. And finally, Anubhav Kaul, MD MPH, a member of the RightCare Alliance, notes in a Health Affairs blog that the Lown Institute’s work to build a grassroots movement for change in medicine is essential to strengthening patient engagement.


A NEJM study found that a government-mandated surgical checklist implementation in Canada had no positive effect. Lucian Leape, MD, discusses in an interview with AHRQ his take on why the implementation failed to produce results. Accelerating change, he says, requires the dedication of leadership and resources, and ought to take guidance from successful process change demonstrations (like the Keystone Project). The key is to understand that checklists are not as simple as they might seem, and that moving toward positive change will require less focus on the specifics of safety practices, and more on modification of workplace and culture.



  • Save the Date: Tuesday, June 2, 12-1 pm ET: Join us for our second webinar to learn about implementing a RightCare Rounds at your institution. Our presenters are David Bor, MD; Brandon Combs, MD, FACP; and Hyung (Harry) Cho, MDLearn more and register here.


  • We recommend watching Consider the Conversation 2: Stories about Cure, Relief, and Comfort,  on PBS this week, the story highlighting the friction doctors feel with their seriously ill patients who want their doctors to inspire them to beat a deadly disease. Prominent physicians including Diane Meier, MD, one of the keynotes at the Road to RightCare Conference, share their insights and shed light on the medical success that created this problem. Check your local listing for day and time.


  • Professor Sir Michael Marmot, the Bernard Lown Visiting Professor of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health, recently had tea with Dr. Lown at his home. You can read his reflections on the conversation, Taking Tea with Bernie, at the UCL Institute of Health Equity blog.




Patient communication


Evidence-based medicine


Social determinants




Health disparities




Hospital care




Payment system


Emergency care


Medical education








Malpractice reform


Drug prices




End-of-life care


Palliative care


Public health


Quality metrics


Practice models


RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.