Dr. Andrew Morris-Singer, Founder and President of Primary Care Progress

(Music)

Mark Masselli: This is Conversations on Health Care I’m Mark Masselli.

Margaret Flinter: And I’m Margaret Flinter.

Mark Masselli: Well Margaret there’s a lot of rumblings going on in Washington
and it’s not just in digestion from the food the y’re eating down there, but it’s also
about the budget they’re trying to deal with.

Margaret Flinter: The Obama A dministration presented a budget proposal today,
warning members of congress that tough de cisions have to be made to jump start
stall budget n egotiations between the democrats who want the preserve social
programs and the republicans who have to repeat that vow no new taxes.

Mark Masselli: You know the President seems to be setting the stage for a grand
bargain that will hopefully bring about a final budget approval from a very divided
congress. And that means cuts to some programs that were considered
sacrosanct in the past Medicare and social security .

Margaret Flinter: The President is trying to issue a budget that both addresses
the defi cit and protects those social safety net programs, something that both the
democrats and the republicans agree must happen. But no agreement on just
how they’re going to achieve that end.

Mark Masselli: He’s taking on some friendly fire from democratic allies who are
concerned about the propose $400 Billion cuts in Medicare that have been
floated around. The President says, the cuts will come in the form of reduced
fees pay the pharmaceutical companies, and by asking wealthy seniors to pay
more for thei r Medicare coverage.

Margaret Flinter: So Mark there’s another announcement last week that maybe
with all the budget talking, gun control talk going and it didn’t get so much air
play. And that was the announcement from health and human services, that t he
federal government was delaying setting up multiple insurance plan s on the
federal health insurance exchange until 2015 , a year after they’re suppose to be
ready for small business to shop for.

Mark Masselli: Certainly with 33 states deferring to the federal government to set
up the exchanges, it’s required a lot more preparatory work. So when the final
Affordable Care Act kicks in ful ly in 2014, small business es will have at least one
plan to choose from and then in 2015 multiple plans would be tear then .

Margaret Flinter: But our guest today is a vocal advocate for improving a
different aspect of Healthcare. Mark, Dr. Andrew Morris - Singer is the founder of

Primary Care Progress, a grassroots organization that he co - founded to improve
advocacy and support for developing the new primary care workforce pipeline.

Mark Masselli: They promote legislation that will improve access to training for
primary care , Margaret and I are both going to join Dr. Morris - Singer at a
conference this weekend at Quinnip iac University School of Law on primary care
and the law.

Margaret Flinter: We’re expecting some exciting and innovative ideas come out
of that event and generally some exciting and innovative ideas coming out of that
whole campus, Mark?

Mark Masselli: Quinnipiac is also soon to open its new medical school, just a few
months away in August. Its focus is on training the next generation of primary
care providers.

Margaret Flinter: Also today FactChecks.org’s Lori Robertson checks in on the
false claim that insurance rates will swore by 30% due to the Affordable Care
Act.

Mark Masselli: And as always if you have comments e - mail us at chcradio .com,
or find us on Facebook or Twitter, we’d love to hear from you.

Margaret Flinter: We’ll get to our interv iew with Dr. Andrew Morris - Singer in just
a moment.

Mark Masselli: But first here’s our producer Mari anne O’Hare with this week’s
headline news.

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Marianne O’Hare : I’m Marion O’Hare with these health care headlines .
President Obama has issued h is budget proposal and the President is already
incurring a fair degree of pushback from his own party. The President’s budget
seeks to reduce a deficit by just under two trillion dollars in 10 years but will cut
into some popular social programs to do it . As projected cut to Medicare
spending by 400 billion dollars over 10 years, social securities benefits formula
will be kept as well reflecting real growth in inflation. But analyst warn ed that will
present seniors within unfair burden as they tend to s pend much more of their
income on Healthcare. Members on both side of the isle are expressing concern
over the budget , democrats warning it puts an unfair burden on seniors while not
raising tax revenues. Republican saying they are only interested in dea ls where
there are no tax increases.

Marilyn Tavenner bipartisan support who had the centers for Medicare and
Medicaid, Tavenner’s been acting administrators since replacing Don Berwick in

late 2011. She went before the senate finance committee yesterday , and unlike
her predecessor who is appointed by President Obama during a Congressional
Recess , Tavenner is expected to face less resistance from opponents.

W ell the University of Hartford is a backdrop President Obama appeared and did
not make state to s how support for strict gun control measures passed in
Connecticut, the governor recently sign laws banning certain assault weapons
and large capacity magazines in wake of the deadly Newtown tragedy which left
28 dead including the gunman. They’re tiny but they pack a terrible punch and
they’re back, with a budding growth of spring comes an unwelcome menace tick
season has already reared its head in certain parts of the country where spring
has come early, cases of tick born disease like lyme disease alread y starting to
crop up in hospitals and emergency rooms, bottom line if you want to avoid lyme
disease cover up completely when working in the garden or hiking in the woods.

I’m Mari anne O’Hare with these health care headlines.

(Music)

Mark Masselli: We ’re speaking today with Dr. Andrew Morris - Singer President
and Principle Founder of Primary Care Progress, an organization form to
reinvigorate primary care training delivery and practices in the American
Healthcare setting. Dr. Morris - Singer is practicin g internist at the New Patient
Centered Medical Home at Brigham in Women in Boston, he’s also an instructor
at Harvard Medical School where he earned his medical degree, Dr. Morris -
Singer is a long time community activist and organizer and is growing the
P rimary Care Progress message across the country at multiple teaching
hospitals and community health centers. Dr. Morris - Singer , welcome to
Conversations on Healthcare.

Dr. Andrew Morris - Singer: Thank you so much for having me.

Mark Masselli: Andrew , y ou joined us here on Conversations on Healthcare
back in 2010 , your organization was just getting under way you launch Primary
Care Progress while still a resident primary care as a response to Harvard
Medical School defunding of the primary care division. And your advocacy has
obviously led Harvard to agree to create a new center for primary care at Harvard
Medical School which is exploring innovations in healthcare delivery in place of
the pre - existing division of primary care. So two questions, one how is the center
for primary care at Harvard Medical School different from the old primary care
division , and how is the training in primary care changing as a results of your
efforts there ?

Dr. Andrew Morris - Singer: When we start organizing back in 2009 w e thought
that the community of the primary care providers and trainees really need to be a
part of establishing a new vision for what primary care programming could look

like in Harvard. And when we came together as a community in a series of town
halls, we needed a community space, we wanted to engage all members of that
community, so the faculty, the students we wanted a different disciplines of
primary care represented family medicine pediatrics internal medicine. We want
a trainees engaged, we want t o focus on clinical innovation, so new ways of
delivering care and new ways of training and we wanted to really build a new
generation leader s . And the new center embodies all of that, specific
programming directed at each of those different areas, now ex ist many trainees
came to Harvard in this most recent class because of this center. So it’s created
new facts on the ground and new culture that values primary care at the school,
and it’s been incredibly inspiring for all those of us who -- who’ve watche d it
developed.

Margaret Flinter: Well Andrew I understand you now at over 25 teaching
institutions around the country, tell us about the grassroots movement as it
spreads across the country. How does it look at some of the other teaching
hospitals at p laces like Baylor or Yale or Stanford in California where maybe
primary care was going down the same slop that you had observed at Harvard?

Dr. Andrew Morris - Singer: I think the bottom line is we’re harnessing a basic
social strategy that’s been used in every other social movement in this country.
So if you look at some of the basic characteristics of that movement, it’s playing
out in each of these communities, these 25 chapters that you’d talked about. So
number one, we’re engaging the full primary ca re team, right? All disciplines ,
medicine, internal medicine, pediatrics all the professions, nurse practitioners,
social workers a nd it’s breaking down the silos that previously separated this
folks from each other which is fairly typical in your average academic institution.
So for instance, University of Utah chapter out in Salt Lake City that team is
composed to pharmacy students, physician assistant students, medial students
all working together to create a new space for trainee engagement in primary
care clinical innovation.

The second major aspect of what we’re doing is, we’re getting folks to see an
opportunity to take action, right? This isn’t just about people coming together to
talk, it’s about harnessing resources and connections to built som ething new. So
at Baylor School of Medicine down in Huston Texas, these students are working
with faculty to create new primary care innovation opportunity, so they’re paring
students with faculty to do patient centered medical home transformation
project s, where the students is really in the driver seat of some of these
innovation projects. And finally I think these chapters are engaging in strategic
thinking and planning in a way they haven’t done before, they’re re - branding
primary care practice, they’ re utilizing story telling as a leadership practice , s o
we’re no longer just presenting the data on the importance of new models of
care, but we’re also coupling that to stories about what it’s like practicing in these
new models, what it’s like training i n these new models, where teams are

everything. And these are few skills that most trainees have previously not been
taught.

Mark Masselli: Well Andrew on of the big stories obviously that’s been front and
st
center for the last couple of years as the Affo rdable Care Act, and on January 1
2014, upto 30 million people will be able to enter the primary care system. When
the analyst s take a look at the potential for 30 million new enrollees , they’re
estimating about 30,000 primary care provider short fall. So tell us about some
of the innovations that are being explored at your patient centered medical
practice at Brigham and Women’s as well as the primary care progress that are
setting an example for the way the medical community should address this
loomin g short fall.

Dr. Andrew Morris - Singer: Number one we are acknowledging the fact that there
are so much to be done in primary care these days for the patient right in front of
you . That are ol d modeled of the doctor trying to do everything and trying to be
everything to everyone, it doesn’t work, it’s just too much to do a nd when I try
and do everything for the patient right in front of me, I’m actually doing a ton of
stuff that’s actually not the best use of my skill set, right? I’m practicing below my
training. And frequently I’m trying to do stuff that I’m not very good at either, for
instance motivational interfering it’s not something we get a ton of training on
behavioral health, integration and focusing on those things. It’s not something
that’s been a big focus of training so we’re engaging other members of the care
team increasingly in these practices , the social worker, the pharmacist, the
physician’s assistant , sharing the care with those folks in an interdependent
manner that gets the patien ts all the stuff they need. So our practice has a social
worker sitting side by side with the physician working to manage patient’s
depression and anxiety and connect them to community resources but the
average probably doesn’t know very much about it.

I ’d say the second major thing is that we’re no longe r practicing just reactive
care. When we just focus on those folks we’re missing out understanding who
are the diabetics in our practice, who are the people with high blood pressure ,
they might not come in here if require them to call. But if we reach out to them
they’ll actually show up, so we’re creating population registries of our asthmatic,
of our diabetics and we’re working as a team to reach out to them , bring them in
and managed them . And I’d sa y the final piece is we’re engaging in care delivery
that’s much more patient centered. So we’re increasingly figuring out ways to
substitute telephone en counters, e - mails visits for that traditional face to face
visit. It works better for patients, it w orks better for us and I think the pairs are a
lot happier too.

Secondly we’re figuring out ways to engage patients in their own care, patients
are one of the most underutilize constituencies on the care team, it’s what they
do and don’t do that makes the difference in their care. So we’re finding ways to
engage them with motivational interviewing or creating group visits, we’re

basically working to help them become a more integrated member to care team.
Patients are happier they’re going to the emergenc y room, last the quality of care
is improved and all of this for lower spending it’s kind of a no brainer.

Margaret Flinter: Well Andrew, you know, we had a match day a few weeks ago
across the United States where the graduating fourth year medical stude nts met
with the residency, the bright spot this year an additional 400 students were
actually seeking primary care residencies up over the year before but the
troubling counterpart I understand there are about a thousand medical students
who weren’t able to match with any residency because there just weren’t enough
slots available. I understand you’ve been looking at this problem in primary care
progress and what’s your perspective on this problem and the disconnect at the
same time that we’re saying we n eed more people to choose primary care and
saying oops not quiet enough slots to give them all residencies.

Dr. Andrew Morris - Singer: We did see 400 more students choosing primary care
residencies but in the aggregate I don’t think we saw a lot more peop le choosing
primary care careers. Still over 50% of family medicine residencies were not
picked up by domestically trained students. So I don’t actually think we’re seeing
an increase interest in primary care among the students right now. But the good
n ews though is that over the past two weeks I’ve been on the phone with
program directors of different primary care residencies, and they’re all saying the
same thing . This year they’re seeing some of the best and brightest students
applying a primary care , they’re seeing some of the most inspired and
charismatic trainees deciding that they wanted to go into primary care. And on
top of that they’re saying that these trainees are showing up asking really
sophisticated questions about new models of care, the y understand that primary
care is transforming itself and they want to be a part of the solution, they
understand some of the challenges of doing that work. What’s exciting about
that is to fix the primary care pipeline, we’ve got two issues to fix, we’ve got to get
more people going into primary care but we’ve also got to e nsure that these folks
have a new set of skills. These (14:49 Inaudible) of folks going into primary care
has a new set of skills and they are ready to rock and roll in a rapidly
trans forming healthcare system.

At the same time though, I think our graduate medical education funding system
is very problematic and leads to a lot of the issues that you describe with the
match numbers with the discrepancy between the over all number of prim ary care
positions that exist in this country that is low compared to the shortage of primary
care providers I think there needs to be more -- much more accountability in
graduate medical education, financing and, you know, your average resident
basically takes up $500,000 .00 of tax payer money, to be trained and the fact
that we do not have accountability with these training programs in terms of
turning out more primary care docs and ensuring that they have specific skills for
a rapidly transforming health care system. We got to fix that, we got to fix that
soon.

Mark Masselli: We’re speaking today with Dr. Andrew Morris - Singer , President
and Principle founder of Primary Care Progress and advocacy organization
seeking to improve primary care training deli very across the country by building a
grassroots movement of primary care innovation leaders. Andrew , I want to
continue to pull the thread on this notion of shortage and, you know, you’ve been
working redefining the primary care space making it as we say efficient, effective
and elegant. And I’m going to add the fourth here how do we make it enticing to
move that dial because even though we have brighter people coming into it,
there’s a huge short fall out there and go pass your comfort zone here is it e ither
a larger system things on how we pay providers clearly primary care providers
aren’t compensated like specialist. What do you see in the big systemic changes
that we might need to increase those numbers above the 2 5 or 30% that we
might be getting o ut of medical schools now?

Dr. Andrew Morris - Singer: Mark , what I’ve realized is that you cannot separate
reimbursement from delivery from training. All these three things operate on
each other, you know, there are so many different things operating on your
average primary care train ee and payment is a huge, huge issue because, you
know, on average there’s between 160 and $200,000 .00 worth of debt the golden
handcuffs. But there are other factors playing out that are also emerging folks
from the primary care pipeline for instance we have a hidden curriculum at most
medical training institutions that pushes people towards inpatient hospital based
procedure oriented careers and away from primary care training , we have (17:37
Inaudible) discouragement that goes on in th e s e institution s , people being told
don’t go into primary care you seem too smart for that. We have these trainees
rotating through some of the most antiquated models of primary care delivery
both in their medical school as well as residency years. So it’s multiple factors
playing out and we didn’t even talk about admissions policies, we haven’t even
talk about the fact that the number of students being admitted from rural
environment s has dropped by 50% in 10 years. So we’re not even lettin g into the
schools, those trainees that are most likely to go into primary care, so fixing this
is going to require multipronged solution including loan reimbursement but we
also have to fix payment we’ve got to insure that the trainees are rotating throug h
functional high value patient centered primary care practices we got to fix all
these things to fix the primary care pipeline.

Margaret Flinter: Well Andrew one of the things that we’ve done within our
organization is to take a look at this issue of th e team and team base training I’d
be very interested in hearing how you’re approaching this issue.

Dr. Andrew Morris - Singer: We are operating in the phase so many challenges
that distance and device people operating in the form of a team. We have a
cult ure of the loan provider, where trainees are actually educated to be
everything to everyone, then we go into a reimbursement environment that in
many practices actually doesn’t even pay for the services perform by non MD

members of the care team. So we’re actually disincentivising team base care, so
the first step I think is number one, you got to get trainees learning together right
from day one, I think some of the most innovative places around the country
have figure that out they’re creating spaces whe re social work students and MD
students, you know, pharmacy students can work on a team together and really
figure out how to so lve clinical problems together.

Secondly, you know, practices are figuring out ways to engaged all members of
the care team, th ey’re getting their larger institutions to invest and they’re
retraining themselves, who should be, you know, on the frontline of managing
people’s diabetes, that’s not the type of thing where that information should be
coming from the government, that’s a local team figuring out the most effective
efficient way of using their existing resources to serve the needs of the
community.

Mark Masselli: We’ve been speaking today with Dr. Andrew Morris - Singer
President and Principal Founder of Primary Care Progre ss committed to
revitalizing the primary care pipeline of workers. You can learn more about their
work by going to primarycareprogress.org. Andrew, thank you so much for
joining us on Conversations on Health Care today.

Dr. Andrew Morris - Singer : Thanks so much for having me.

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Mark Masselli: At Conversations on Health Care we want our audience to be
truly in the know when it comes to the facts about healthcare reform and policy.
Lori Robertson is an award winning journalist and managing editor of
Factcheck.org , a nonpartisan, nonprofit consumer advocate for voters that aim to
reduce the level of deception in U.S. politics. Lori, what have you got for us this
week?

Lori Robertson: Well, house republicans in the White House once again treated
claims about what the Affordable Care Act would do to insurance premiums.
There was a new analysis out published by the Society of Actuaries that said for
the individual market that’s for the exchange will operate. The cost for insurance
companies per me mber, per month would go up to 32% but Republicans on the
House Committee on Energy and Commerce claimed at the actuaries had said
that the average premium would increase 32%. The report didn’t say that at all.
In fact it explicitly said it wasn’t giving an estimate on premiums. It did say that
cost for insurers would go up as a less healthy population joins the individual
market. It's true that if costs go up they will likely be passed on to consumers but
we don’t know what exactly will happen to the p remium s . The Congressional
Budget Office meanwhile estimated that premium s would go up on the individual
market but by 10% to 13% and most of th e s e buying plans through the
exchanges would get federal subsidies that bring their cost way down. The

White H ouse pointed to that CBO report saying that average premium s would
actually be lower in the future for the same level of benefits. And that’s the catch
plans in this market are expected to have much better coverage in the future than
they do now because t he Health Care Law require certain minimum benefits.
And those increased benefits are exactly why the CBO estimated that the
average premium would go up.

And that’s my FactCheck for this week . I am Lori Robertson , Managing Editor of
Fact C heck.org.

Marg aret Flinter: Fact C heck.org is committed to factual accuracy from the
country’s major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you’d liked
checked e - mail us at chc radio.com, we’ll have Fact C heck.org Lori Robertso n
check it out for you here on C onversations on Health Care.

(Music)

Margaret Flinter: Each week conversations high light s a bright idea about how to
make wellness a part of our communities and to everyday lives. New York City
Mayor Michel Bloomberg has been taking a number of hits lately for attempting to
ban everything from Styrofoam packaging for takeout food, to large sugary drinks
in restaurants and city run facilities. Bloomberg has none theless forg ed to head
he sites his interest in not only improving the health of his New York City
constituents but in setting an example for other public officials to follow around
the country. It's been 10 years since Mayor Bloomberg launched his first
controversia l ban ending smoking in bars and restaurants throughout the city ’s
five burrows. The propose d smoke free air act was met at the time with a
hailstorm of criticism and dire warnings of loss business and tax revenue due to
the ban. But at a recent gatherin g at a vulnerable old New York City Watering
Hole the Old Town Bar of Union Square , Bloomberg share fa cts that borrow quite
a different story since the ban went into a fact health officials estimate that
10,000 lives have been saved and reduce smoking rate s in a dramatic reduction
and exposure to second hand smoke. And the restaurants and bar owner swept,
they have apparently seen the light as well. The Mayor was flanked by Old
Town’s owner Gerard Meagher who was one of the ban d most vocal opponents
at the time. Meagher compared his taverns receipts from before and after the
ban and found his business actually increased by 20% turns out once the ban
was in place in the perennial blue haze of smoke was gone people began to
spend more on the restaurant food. Smoking bans are now come in place
across the country , b oarding well for the health of those working in bars and
restaurants as well as the patrons . A municipal smoking ban that not only
improves a health and wellbeing of workers and patrons but it has turn out to be
good for the business bottom line as well. Now that’s a bright idea.

(Music)

Margaret Flinter : This is conversations on Health Care I am Margaret Flinter .
Mark Masselli : A nd I am Mark Masselli , peace and health.
Conversations on Healt h Care broadcast from the campus of WESU at Wesleyan
University streaming live at wesufm.org and brought to you by the community
health center.