In 1932, the Committee on the Costs of Medical Care concluded: “Many of the difficulties in present medical practice can be overcome, wholly or in part, by group organization. . . Some of these difficulties are: lack of coordination . . . lack of adequate supervision and control over the quality of medical care . . . the difficulty experienced by patients in choosing qualified physicians; the unnecessarily large expenditure for overhead costs made by practitioners in individual private practice; and the increasing complexity of medical service.”

In 2001, some seventy-plus years later, the Institute of Medicine’s Crossing the Quality Chasm report concluded the very same thing, calling for a new model for the 21st century health system, noting that the current health care system “cannot do the job.” Sadly, little progress has been made since the 1932 report.

The traditional solo physician practice—a “non-system” method of providing health care—is one part of the problem. Americans continue to be served by a fragmented, uncommunicative health care system that drives up the cost of care without necessarily improving its quality.

Employers and patients are frustrated by the increasing financial burden and are demanding greater accountability from the providers of American health care.

Alternatives to our fragmented health care system are sorely needed. The “cottage industry” approach to medicine has not produced the quality and efficiency results we want and need.

The American health care system is facing a crisis. But there is a solution:
The Accountable Physician Practice.

“CAPP’s 35 MSMGs [multispecialty medical groups] share a common vision as learning organizations dedicated to the improvement of clinical care. Their features include physician leadership and governance; commitment to evidence-based care management processes; well-developed quality improvement systems; team-based care; the use of advance clinical information technology; and the collection, analysis, and distribution of clinical performance information. These features are congruent with the [Institute of Medicine’s] recommendations on key elements needed to redesign delivery systems.”

From Chapter 5, “Developing the Test Bed—Linking Integrated Service Delivery Systems: Council of Accountable Physician Practices,” by Michael A. Mustile, MD. The Learning Healthcare System: Workshop Summary (IOM Roundtable on Evidence-Based Medicine), edited by LeighAnne Olsen, Dara Aisner, and J. Michael McGinnis, National Academies Press, 2007.

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“A shift from the current care model to a more coordinated care model centered on primary care is one potential way to help stave off the healthcare dilemma.”

“It's too expensive to be a primary-care doctor,” by Debra A. Geihsler, president and CEO of Harvard Vanguard Medical Associates & Atrius Health. Boston Globe, July 25, 2007.

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Medicare Payment Advisory Committee’s March 2007 Report to the Congress: “In three of the four [metropolitan statistical] areas, beneficiaries whose main physician was in multispecialty or hospital-affiliated groups had lower average annual spending than beneficiaries whose main physician was in solo or single-specialty groups. At the highest quintile of spending, all four areas show lower average spending for beneficiaries whose main physicians were in multispecialty or hospital-affiliated groups.”

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