Poll: What are the obstacles to the patient centered medical home?

The patient centered medical home is a health care setting that facilitates partnerships between patients and their physicians, through the use of both an integrated team-based approach and information technology. It is a model that is often hailed as a savior of primary care medicine.

What is the biggest obstacle to the patient-centered medical home becoming a reality?

Infrastructure costs. Transforming a practice to a medical home requires a fundamental change, including mandatory adoption of electronic medical records. This is a challenge to the 36 percent of physicians who work in solo, or small group practices, and can be particularly difficult in rural areas. When you consider the fiscal circumstances facing doctors today, how are they able to radically convert their practice to meet the strict criteria the medical home demands?

Government support. Senator Max Baucus recently released a white paper, giving guidance to future health care reform. In this plan, he stressed the importance of the medical home. It is imperative for Medicare to realize the potential cost savings that the model can bring, and spend money to properly reimburse the primary care physicians staffing the home, as well as helping practices acquire the necessary information technology.

Specialist support. The American Medical Association’s House of Delegates recently endorsed the medical home. However, the reality is that any increased payments to fund the initiative will be “budget-neutral” in nature, meaning that specialists will face decreased reimbursements. Could this temper their support?

Primary care physician shortage. If you build the medical home, will the primary care physicians come? The number of medical students entering a generalist field is at an all-time low. Even with adequate funding and political backing, there is no guarantee there will be enough doctors to meet our growing primary care needs. Is the situation already too dire for the medical home to save?

If I didn’t cover your issue, you can add it in the comments below, or call into the ReachMD Listener Line at 888-639-6157 and record your comments (portions of which may air).

I encourage you to listen and vote in this week’s poll, located in the upper right column of the blog.

Please suggest future ReachMD Poll topics by emailing Poll@ReachMD.com

Comments are moderated before they are published. Please read the comment policy.

  • Carla Kakutani MD

    You’ve laid out several obstacles to the patient centered medical home, but rather than dwelling on why it can’t happen, I’d like to focus on why it is so important to our nation that it DOES happen. For health care reform to have any chance to reverse the current US trend of paying more money for poorer outcomes, we need to have a vision that does more than just expand coverage. The medical home can provide this. Without it we face health care costs that continue to spiral with no end in sight.
    Family physicians are frustrated when the things they were trained to do and they know save money in the long term, such as care coordination and education, are not valued or rewarded in the system. The medical home, by aligning incentives, would solve this and make primary care much more attractive.
    I precept medical students and physicians in my office and work with many enthusiastic and dedicated students and residents through the CA Academy of Family Physicians. This next generation of doctors has a desire to serve–they just need the system changed to make it possible.

  • Jaywon

    I believe that the biggest obstacle to achieving a meaningful and sustainable patient-centered model in U.S. health care is not listed among the options you have provided on your blog. I would argue that lack of political will is the key obstacle. Until patients and physicians work together towards successful implementation of the medical home model, there will be little to no political pressure to eliminate the status quo. This November’s historic election proved that we, the people, can make change when we want to. Here in Long Beach, we registered patients to vote and implemented get-out-the-vote efforts in a non-partisan way. There was an overwhelmingly positive response from our patients. The “system” can be changed; imagine if we harnessed the political power of the 47 million uninsured patients in our nation to ensure that every patient had a medical home.

    I have the privilege of working with medical students and family medicine residents, virtually all of whom have chosen to enter the medicine to provide a medical home for their patients. Imagine if we coupled the patient voice with a physician voice.

    Jay W. Lee, M.D., M.P.H.
    Memorial Family Medicine

  • Joseph E. Scherger, MD, MPH

    The emergence of personal health records will impact this movement and make it more efficient. Through Google Health, Microsoft HealthVault, Dossia and others, many Americans will soon have a web based medical home. This home will connect to their primary care team for a new platform of communication and care. People will increasing do more self-management of their preventive services, chronic illness care and behavior change, and the primary care physician will be the coach/consultant/facilitator. Kevin, your Blog keeps all the work on the primary care physician. When patients take charge, the transition will not be as hard as you think.

  • Govindan

    It is difficult to have patient centered medical home, but with the mutual understanding it can be successfully done. Almost all the point have been covered, I would like to know more about the success of it. So please let me know more about this.

Most Popular