| May 20, 2008
Can the medical home deliver?
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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.
What a nice, cozy word “medical home!” It is a wonderful concept and I have no doubt it would save Medicare $$ because it is an outpatient program that is people and resource intense with all of the coordinated care, counseling, emailing and open access.
No small group or independent physician will be able to offer “medical home” because there will be no reimbursement that begins to cover the bells and whistles. Even raising Medicare reimbursement by 10% (which is not proposed) would not begin to cover the extra staff needed. It also requires an electronic medical record. Let’s talk real money!
The only way for “Medical Home” to work financially is as a “lost leader” for integrated institutions that need those referrals for high priced items like procedures, scans, surgery and hospital stays.
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.”
$500-800 a year? Is that just for the medical home part?
Given what even simple things cost I don’t see how you could treat sick people for that.
I need a new Bentley GT for $500.
I am not sure what the difference is between the “Medical Home Model” and what I already do in my family practice, other than perhaps some increased reimbursement. I already have an EMR, coordinate care, provide 24/7 access via phone and have extended hours. I am not proceeding with email communication until reimbursement issues have been resolved. I don’t want email to be just another “non-reimbursable.”
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.
Medical care is at Walmart prices to doctors. Say Medicaid sometimes pays $12/- per visit in some states. It is the insurance companies which charge the patients more.
“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.
The federal lawyer thugs running 99% of the government have granted the HMO immunity. They will arrest and crush two doctors asking each other their fees over dinner for anti-trust violation.
One has to ask what has to be done if the Mafia comes to the neighborhood and has started threatening people for their money. Can one negotiate with the Mafia? No. There is only one thing that can be done with the Mafia besides caving in and losing the business one has worked hard to build.
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