When looking to examine patient-centered medical home data, there’s no better place to start than the 26-month evaluation of the multi-site National Demonstration Project. Begun in 2006, with results published in 2010, this federally funded project included an array of repeated cross-sectional surveys and medical record audits at baseline, 9 months, and 26 months, using patients from 36 family practices that were randomized into two groups: those practices that received ...

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Merrill Markoe's reports that she was fired by her doctor in her article, "My Doctor, the Concierge," which was both sarcastically entertaining and painfully true.  She writes a powerful commentary on the divide caused by insurance companies between doctors and patients.  She is shocked at the rapidly growing trend of an access fee to see concierge doctor and yearns for the Hippocratic Oath’s “May I long experience the joy ...

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"Just start work half an hour earlier." This is what the head of the care coordination committee for our patient-centered medical home executive committee work group recommended when we talked about our struggle getting the team together for early-morning pre-clinic huddles. She suggested that if we started our usual practice morning at 8 o'clock we should just have everybody come in at 7:30 to load the dashboards for the morning session ...

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Mr. Heim Stillear, at 70-years-old, seems older and less intelligent to his family, since he was hospitalized for a stroke about two months ago. They come to the appointment with him and help him into the exam chair. When I ask Heim what is going on with him, the long pause before his strained answer begins makes his family uncomfortable. His daughter interjects, “We are having a very difficult time understanding ...

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The Affordable Care Act (ACA) will increase insurance coverage for the poor, uninsured and minorities, but will it improve access to care and population health? The answer depends critically on whether or not physicians are available to care for the newly insured. Many health policy experts fear there may not be. While the ACA contains some modest pay increases for doctors willing to see patients with Medicaid (the means-tested joint federal-state ...

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The term “open access” in the context of primary care means that patients are able to get an appointment whenever they wish. The ultimate in open access is 24/7 availability. No, I don’t offer this, although I come pretty close. I’m available by cell phone virtually 24/7 and I’m also almost always willing to come in and see someone if they really need to be seen. This seldom happens. Most of ...

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The high cost of free, unnecessary medical equipmentA guest column by the American College of Physicians, exclusive to KevinMD.com. A couple of weeks ago, a television commercial caught my attention. It was an official-sounding announcement, a “national healthcare alert” that if you have Medicare, you might qualify for a knee brace “at little or no cost to you.” I found it interesting because a week earlier, a durable ...

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Doctors are tough critics -- as well they should be. The news that CVS Caremark pharmacies will no longer sell tobacco brought about quite a bit of rapid online dialogue. Even President Obama chimed-in with praise, a response that some in the business world say is worth billions for CVS. Having a good reputation, particularly when you’re in the business of delivering health care and lending health advice, seems essential. In my ...

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Are you a practicing primary care physician, board-certified in either family medicine or internal medicine, and in good standing with your state licensing board? Do you have concerns about the relative lack of primary care professionals, especially now that 40 million new patients have been added to the U.S. health care system this year? What if I told you that you, simply by carrying on with your usual daily primary ...

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The goal of the Affordable Care Act is to make affordable, quality health care coverage available to more Americans. But how many physicians will America need to satisfy this new demand? The debate over doctor supply rages on with very little conclusive evidence to prove one case or the other. Those experts who see a shortage point to America’s aging population -- and their growing medical needs -- as evidence of a ...

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