Comments on: The medical home in health reform’s attempt to fix primary care

By: Miriam Volpin

Miriam Volpin — Mon, 21 Dec 2009 02:32:41 +0000

Why do you say it excludes primary care doctors alex?

As for preventative services save money, I think it depends on how you analyze the data. For example, several studies involving on-going home visits to at risk mothers by home health nurses found that, not only did the women have fewer problems with parenting but they spaced their pregnancies further apart, and there were lower incidences of abuse. Following the children over time there were higher rates of HS graduation and lower rates of criminal activity.

Seems to me that’s some pretty major cost savings to society.

By: alex

alex — Sun, 20 Dec 2009 05:51:59 +0000

Well, I’m sure the primary care doctors will be totally on board with the idea that the “medical home” excludes them so much that it shouldn’t even be called “medical”. Yikes.

In other news, I continue to await actual evidence that this saves money. Most of these “preventative services will save money!” ideas appear to have failed miserably when actually implemented and analyzed for cost savings. Honestly, the real problem US health care is so bloody expensive is that the “standard of care” is a million times higher than the rest of the world. And it’s not going to be any cheaper until there’s some mechanism to push doctors to not order every CT, SPECT or coronary cath that walks in the door.

By: Miriam Volpin

Miriam Volpin — Sat, 19 Dec 2009 21:20:16 +0000

This might seem trivial, but I have a real issue w/the name “medical home.” To quote Mathy Mezey, EdD, RN, FAAN (director of the Hartford Institute), and also in alignment with the quotes in the original post “Consistent with past and current practice in models that deliver comprehensive services to patients, nurses in this new model would be the provider responsible for most of the service coordination and patient follow-up. And in fact, nurses achieve impressive patient outcomes when they coordinate services to complex patients.”

Some other suggestions:
“Health home”
“Caring home”
“Care management”
“Health Care Management Home”
“Health Care Home”

By: David Voran

David Voran — Sat, 19 Dec 2009 20:12:59 +0000

We’re obsessed with tackling health care costs by bemoaning the poor state of primary care here in this country. I’m a primary care physician and there are times I have to remind myself there are countries that have pretty good healthcare systems where there is no primary care. Japan is one of these countries.
The patient is essentially the “medical home.” The country is populated with private and public physicians of which almost none of them engages in primary care.
I spent the greater part of my childhood in Japan and lived for a stretch in a small town of around 90,000 people. We had a state run hospital staffed by teachers and the equivalent of residents (about a 400 bed hospital). Scattered around town were around 40 hospitals (most were less than 10 beds and attached or above the physician’s clinic). Each of these were specialty hospitals. When I had a stomach ache we trotted down the street to the GI doctor’s hospital, waited in line and got seen that day. When I had a ring-worm, I made frequent trips to the Dermatologist’s clinic and small ward about 2 blocks away. Cut yourself and you go to one of the many surgeon’s hospitals.
Only if it was major did an ambulance come get you and you wound up at the State hospital.
Interestingly each of these places would look at the health card (similar to the Post Office checking account books we had) and if we were behind on an immunization we’d get it at any of those places, or at school.
So we have to think. With information technology and a universally accessible patient record we might not need primary care physicians to deliver coordinated care.