Why not a down payment for primary care, and problems with the medical home?

Earlier this week, President Obama argued that we need to spend money now, in order to curtail the spiraling costs that Medicare and Medicaid will reap on future generations.

However, when it comes to primary care, the Congressional Budget Office is not so forward thinking: “Savings from some initiatives may not materialize because incentives to reduce costs are lacking. For example, proposals to establish a ‘medical home’ might have little impact on spending if the primary care physicians who would coordinate care were not given financial incentives to economize on their patients’ use of services. Those proposals could increase costs if they simply raised payments to those primary care physicians.”

The ACP’s Bob Doherty says you have to spend money to save money, and indeed, increasing pay will make it significantly easer to attract medical students to primary care. And, as I believe the President realizes, no reform plan will succeed without a stronger primary care foundation.

On the flip side, this piece from Health Affairs questions the patient centered medical home concept, which organizations like the ACP are basing their primary care proposals on.

Some of those arguments are valid, including the fact that the criteria to become a “certified” medical home are onerous, and the proposed payments are not worth the cost of transitioning a practice.

Also, the medical home model appears to best flourish in large, integrated health systems, like the Mayo Clinic. The fact that the majority of primary care doctors do no belong to such systems may make it very difficult to switch over to this model en masse.

It’s something that medical home proponents should think about, and perhaps come up with a “Plan B,” in case the concept doesn’t take off.

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