Comments on: Support for the patient centered medical home in the House health reform bill

By: FlaRheumDoc2

FlaRheumDoc2 — Sat, 14 Nov 2009 12:29:12 +0000

Dr. Bent described the House’s Medical Home pilot as an example of “delivering care with a physician-led team of providers working to the full scope of their respective positions”. Yet the Medical Home could be headed by a Nurse Practitioner; a physician led “Home” was not required. Wake up and see that this is an attempt to minimalize physicians and our worth. We will soon be equated to workers and not professionals.

Why isn’t there an out cry about all of this from Physicians? Why don’t we have our own “March on Washington” highlighted by a series of debates between physicians on both sides of the aisle. The public deserves to hear our voices. Physicians deserve a better representation of their views then what is being forth by the AMA currently.

By: NoVA doc

NoVA doc — Sun, 08 Nov 2009 20:54:24 +0000

@Sandra Newman: thanks, we’ll see how the just-passed House bill fares on the way to the White House. Admittedly I’m a skeptic, wondering how the heck I’m going from seeing 16-20 patients/day with 1 MA up to 35 patients/day with 2 RN’s – which is what at least one model PCMH practice does. Not enough money, not enough supporting talent, overpriced hospital EMR, no local IT infrastructure the specialists can readily plug into (i.e. Mayo, Bassett, Intermountain Health, etc.). And like jsmith, I would like to get to know my kids as they grow up, unlike my busy physician father.

I like to actually recall from memory facts about patients that additional time with them affords me – what they do for a living, relationships, children, etc., helps me to look at the big picture rather than a list of ICD-9 codes to address. Could I do that in a busy PCMH setup? Doubt it, there are limits to being merely human.

By: familydoc

familydoc — Sun, 08 Nov 2009 02:19:14 +0000

As a family doc, I support the House Health care reform bill. I look forward to the day when I no longer get phone calls from patients who know they need to come in for preventive care and monitoring of their chronic illness, but they can’t because they no longer have insurance or their deductible is too high. I look forward to the day when we have more to offer the obese patient than bariatric surgery, because the cost-effectiveness of a monitored group physical exercise facility will be understood and reimbursed.
I am lucky to be working with specialists who save lives when their expertise is required. I can count on most of them to not just run up a bunch of tests and procedures because right now that is how to make money as a doctor, and it is easier to do that than try to talk patients out of unnecessary tests.
I look forward to the day when my own work in diagnosing and treating depression, in performing evidence-based preventive care, in helping people manage their own diabetes, in encouraging their own impulses to quit smoking, all will be recognized as just as valuable.
Everywhere else in the world primary care is the backbone of good cost-effective care systems.

By: TrenchDoc

TrenchDoc — Sun, 08 Nov 2009 01:31:30 +0000

DrsFriend

It is all smoke and mirrors. PCP will be paid 3 percent more to do 30 percent more work most of which will be paper work documenting how effecient the medical home is. We are already doig it. PCPs all across the country are already tracking their patients through multiple episodes of care with subspecialists. and hospital ERs. We are getting those results and explaining them to our patients rather than saying, “You will have to ask the specialist.” We just aren’t getting paid for the time and staff it takes to do this. The Medical Home documentation will be the last nail in the coffin for PCPs.

By: DrsFriend

DrsFriend — Sat, 07 Nov 2009 22:28:07 +0000

A friend of mine is a primary care physician and she often talks about how sad it is that so many in her field are leaving because they aren’t paid enough. And medical school students avoid it in favor of specialities simply because of the pay issue.

So this article states that patient-centered medical homes are a lot more cost efficient, but what I don’t understand exactly is just how primary care physicians will be paid the level of salaries they need and deserve. Can someone explain this to me in “layman’s” terms?

Thanks so much for this informative article!

By: Patient Advocate

Patient Advocate — Sat, 07 Nov 2009 19:44:51 +0000

There may be a primary care physician shortage inevitable, however the patient-centered home model sounds like it could be a great solution to this problem. What an amazing concept….patient-centered health care, where the needs of the whole patient are considered and prevention is key. I can’t think of anything better.

As a women’s health advocate, I’ve heard unbelievable stories of women and children dying every day in the US from causes that could have been easily preventable. The infant mortality rate in this country, which is only rising all the time due to the increase in premature births, is sadly much higher than other countries, not to mention the fact that our maternal mortality rate is just as unconscionable due to the pathetically poor level of care of low income pregnant women.

We can’t allow this to continue. Women and babies are dying, and people are arguing over political issues such as federal funding of abortions….come on. The health care reform bill needs to be passed, and quick, so we can make health care affordable and available for all Americans and prevent unnecessary deaths.

By: jsmith

jsmith — Sat, 07 Nov 2009 16:11:49 +0000

Busymom, Welcome to the primary care shortage. It will be solved by and only by paying family doctors a hell of a lot more money. This will not happen, at least in the near term.
Sure, I can get up in the middle of the night (or stay up all night) to keep people out of the hospital so as to save society money and help folks out, but someone has to to pay me and other family docs like me a minimum of $100 per hour net of expenses to do it, and I see no willingness on the part of society to step up to the cashier’s window. Oh, and what about the pts during the day who have only a sleep-deprived doc to see them? Sorry folks, there a shortage on.
The PCMH is a false solution proposed by people who are not actually themselves willing to be available 24/7. It’s a BS solution that has no impact on the root of the access problem. I for one am not willing to run my health, marriage and family life (2 young kids) to pay for America’s failure to provide an adequate HC system for its people. Most other family docs I know feel the same way. It’s your problem America–deal with it.
Here’s the reality: the primary care crisis will worsen, and we will look back with nostalgia at the time when we only had to wait 2 days to see a doc.

By: BusyMom

BusyMom — Sat, 07 Nov 2009 06:23:29 +0000

All I know is that more and more people are heading to the ER, myself included, because it takes forever to get in to see a doctor. When my child has ‘the mother of all’ sinus infections, is running a 102 degree fever, can’t keep food down because of the congestion, can’t sleep, and is crying miserably, and our doctor can’t fit us in till DAY AFTER TOMORROW, then I have no other option but to attempt to console her during a nightmarish 5-10 hour wait in the ER so we can get antibiotics.
The patient centered home, as described in this article, sounds like an ideal solution where I’d have greater access to my doctor. This health care reform bill is a no brainer to me.

By: jsmith

jsmith — Sat, 07 Nov 2009 06:05:48 +0000

24/7 access to access to PCPs. What a joke. Who comes up with this nonsense? Oh, yeah, the ACP. Hey guys, there’s a shortage on! Hello!
This PCMH foolishness is a desperate attempt to get money by making absurd promises to politicians. I can see the med students running for the exits already.

By: Patient in San Francisco

Patient in San Francisco — Sat, 07 Nov 2009 04:51:48 +0000

The Los Angeles Times (http://www.latimes.com/features/health/la-oe-khan5-2009nov05,0,5733860.story) yesterday ran an op ed by a University of California-San Francisco internal medicine resident, who provides a compelling description of why our health care system must provide great primary care access as well as great specialty care – it’s not either/or. With so many people now uninsured and the primary care physician shortage growing worse, though, it’s primary care that so many people lack, until their symptoms constitute emergencies.

Healthy San Francisco (www.healthysanfrancisco.com), our city’s affordable plan, is built around the medical home model to bring a balance.

The medical literature is filled with research and data that show the positive impact of primary care – we don’t need to debate that here.