Making a Business Case for Small Medical Practices to Maintain Quality while Addressing Racial Healthcare Disparities by ProQuest


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Making a Business Case for Small Medical
Practices to Maintain Quality while Addressing
Racial Healthcare Disparities
Frances J. Dunston, MD, MPH; Andrew C. Eisenberg, MD, MHA; Evelyn L. Lewis, MD, MA;
John M. Montgomery, MD, MPH; Diana Ramos, MD; and Arthur Elster, MD; for the Ad-Hoc
Committee of the Commission to End Health Care Disparities

                                                                               the need to provide preventive services, the increasing
  Disclaimer: The viewpoints expressed in the paper are those of               prevalence of chronic disease, the aging population and
  the authors and do not necessarily reflect the views and poli-               the corresponding time necessary for patient-centered
  cies of the American Medical Association or the other organi-                care management add to the frustration experienced by
  zations of the Commission to End Health Care Disparities.                    many primary care physicians.2 Physicians also must
  Various reports have documented variations in quality of                     adjust their practices to accommodate a growing num-
  care that occur among racial and ethnic populations, even                    ber of racial and ethnic minority patients, and especially
  after accounting for socioeconomic factors and health                        patients with limited English proficiency. The nation’s
  insurance status. Although quality improvement initiatives                   racial and ethnic minority population now exceeds 100
  are often touted as the answer to healthcare disparities,                    million and constitutes approximately one-third of the
  researchers have questioned whether a business case exists                   U.S. population.3 With the growing demands of primary
  that supports this notion. We assess various barriers and                    care, it is likely that the most vulnerable in our society,
  incentives for using quality improvement to address racial                   such as low-income racial and minority patients, and
  and ethnic healthcare disparities in small-to-medium-sized                   those who require additional time and care coordination,
  practices. We believe that although both indirect and direct                 will not experience improvements in quality of care not-
  cost incentives may exist, a favorable business case for small               ed in other patients populations.
  private practices cannot be made unless there are addi-                          Numerous scientific reports over the past decade
  tional financial incentives. The business community can work                 have documented the fact that racial and ethnic minor-
  with health plans to provide these incentives.                               ity patient populations, when compared to non-Hispanic
                                                                               white populations, receive a lower quality of healthcare,
  Key words: race/ethnicity n health disparities n quality                     even when controlling for socioeconomic status. The
  improvement                                                                  extent and trends of these variations are chronicled in
                                                                               the National Disparities Report produced annually by the
© 2008. From the Department of Pediatrics, and General Pediatrics, More-       Agency for Health Care Quality and Research, as well as
house School of Medicine, Atlanta, GA (Dunston, A.J. McClung chair,            in reports from other organizations and foundations.4,5
professor and chairperson); Iron Mountain Medical Center, Madisonville,            Although financial access to healthcare is a major
TX (Eisenberg); Texas A&M School of Rural Public Health (Eisenberg), Col-
lege Station, TX; Department of Family Medicine and Medical and Clini-
                                                                               component of health disparities, racial and ethnic dif-
cal Psychology, Uniformed Services University Center for Health Disparities,   ferences in healthcare services persist after accounting
Bethesda, MD (Lewis, deputy director); Professional Relations, BlueCross       for socioeconomic and insurance status.6 Reasons for
BlueShield of Florida, Jacksonville, FL (Montgomery); Department of            these findings are emerging, as are solutions. Attention
Obstetrics and Gynecology, Keck School of Medicine, University of South-       appears to be converging on developing strategies to
ern California, Los Angeles, CA (Ramos); and Division of Medicine and
Public Health, American Medical Association, Writing for the Committee,
                                                                               improve the quality of care for all patients seen in clini-
Chicago, IL (Elster, director). Send correspondence and reprint requests       cal settings, with special attention given to issues rela-
for J Natl Med Assoc. 2008;100:1318–1325 to: Gloria Boone, 515 N. State        tively unique to racial and ethnic minority patients such
St., Chicago, IL 60610; phone: (312) 464-5530; fax: (3
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