The “medical home” is often referred to as primary care’s savior. Maggie Mahar writes a comprehensive piece saying this might be a tad optimistic.
She makes a point that, despite what I say, simply increasing primary care isn’t enough. There has to be concurring coordination of care:
Most primary physicians don’t coordinate care by “collaborating with specialists to ensure both communication and collaborative decision making,” in large part because “our payment system fails to reward office-based physicians for managing disease and coordinating care.” As a result, PCPs don’t have the time to play phone tag with specialists, tease out a list of all of the medications their patient are taking, or organize the information in neatly cataloged electronic medical records.
As long as primary care continues to be incentivized by volume, coordination of care will fall by the wayside.
Another potential problem is the stringent definition of what a medical home should comprise. With the current definition, almost half of physicians in the country will fail to qualify. The initial, seemingly simple, step of implementing electronic records is already meeting significant resistance.
And finally, the carrot simply isn’t big enough. The payment levels that are being discussed provide little incentive for doctors to fundamentally transform their practice:
A proposed payment scenario was recently reviewed in the June AMA News. It shows that Tier 3 (the highest, requiring the most extra services and reporting) would pay an extra $161,871 for a panel of 250 patients. That comes to $53.96/pt/mos which is barely enough to cover two or three extra phone calls.
In the current economic climate, it is unlikely that the money will be there to save primary care. Which means that the medical home concept will stay stuck in the planning stages for the forseeable future.
Related posts:
- Barriers to the medical home
- What if you had a medical home . . .
- Emergency physicians and the medical home
- Encouraging news on the medical home
- Does the AMA really support the medical home?
- Poll: What are the obstacles to the patient centered medical home?
- My take: Slow medicine, destroying the medical home, animosity, patient communication
{ 1 comment }
The medical home concept makes sense in theory, but it still needs a lot of work. The payment structure clearly needs addressed and the issue of coordination is the 800 lb gorilla of issues to tackle.
I think we could come up with some of the funding for primary care simply by utilizing more NPs and PAs. They would be a more cost-effective means of increasing our preventive care utilization, as well as increasing care coordination. If I haven’t scared you off, I encourage you to read my blog post from 9/29 which includes a link to a very interesting medical home discussion.
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