"What we need is concierge care for everyone at Wal-Mart prices"

The “Medical Home” is a third rate medicaid clinic with glossy PR, something only a British NHS hack or their Massachusetts counterpart would foist on the sheeple.

Caveat emptor, suckers.

Why is this “medical home” being touted as something new? It is not. In my family practice residency in the 1970′s, every family doctor’s office was supposed to serve as a medical home. We treated about 85-90% of all medical issues in the office and coordinated specialty care for the rest. The problem was that as payments for our care lagged behind more and more along with the increasing intrusion of managed care, we just could not afford to do more and more work for less and less. Simple as that. You get what you pay for. Electronic records will not change that. Internet prescription refills will not change that. Today’s “medical homes” will have to deal with the same arcane coding system with even more complexity, even higher office overhead costs, and no break from the endless pre-approval requirements from managed care. No, I think the new “medical home” will just be an electronic “medical nightmare.”

I need a new Bentley GT for $500.

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Guess what…

The big issue is, who is going to pay the mortgage on the medical home? Doubt that Medicare will step up to the plate given that it’s steadily going into bankruptcy anyways and the baby boomers ain’t even there yet. As far as private payors go, so far they’re not putting their money where their mouth is in terms of funding EMR’s, extra office personnel, etc. It’s also a death knell for solo practitioners and small groups, whose ability to extend office hours without sacrificing health, relationships and sanity is extremely limited. Great idea as long as someone else except the provider is paying for it. Otherwise, it’s likely a lot of medical homes will ultimately end up in foreclosure.

“The problem was that as payments for our care lagged behind more and more along with the increasing intrusion of managed care, we just could not afford to do more and more work for less and less. Simple as that. You get what you pay for”

And you get paid what you insist on. Family practice doctors griped but accepted the lower fees upon which they now can’t provide that level of service and therefore are ultimately responsible for it’s demise. Whether due to fear of financial loss, or as I think more the case, misguided altruism that made them inhibited about cutting all payors out of the practice that did not pay enough to support top notch service–even if that meant cash only–the result was to be resonsible for colluding in the destruction of top quality care.

If doctorjay only looks to third parties to pay, his service will only be valued at what people who don’t need it think it is worth.