subject: Is A Medical Home in Your Future? [print this page] Is A Medical Home in Your Future? Is A Medical Home in Your Future?
Submitted by Dr. DG Comfort, CO
The Medical Home, AKA Patient-Centered Medical Home (PCMH), is defined as "an approach to providing comprehensive primary care that facilitates partnerships between individual patients, and their personal providers, and when appropriate, the patient's family. The goal of the Medical Home is provide better healthcare for the patient, a less stressful environment for the Doctor, and at less cost to everyone.
The concept of the Medical Home has been in existence since 1967 when it was introduced by the American Academy of Pediatricians to provide better healthcare for children with severe medical problems. The whole idea of providing better healthcare at a low cost is very attractive politically, especially now that the Healthcare Reform Bill has passed. But is the actuality of a Medical Home the same as its theoretical goal?
How, exactly, does the Medical Home model aim to achieve its goals? There are several factors involved within the Medical Home concept:
1) Every patient chooses a primary physician from among the medical providers within the Medical Home. This primary provider will co-ordinate all medical that the patient may require throughout their lifetime. Costs are contained because duplicate treatment is minimized.
2) Medical records are available to everyone within the Medical Home to improve treatment effectiveness and minimize duplicate services. With ready accessibility of medical records, emergency treatment can be administered more timely and safely.
3) With extended hours and locations, the Medical Home provides easier accessibility to the patient and will decrease the need for ER visits, helping to control costs.
4) Reimbursement for care provided needs to be allocated based on outcomes and distributed amongst the Medical Home team. This is dramatic change from the current fee-for-service policy.
For those of you paying attention the Medical Home model sounds an awful lot like an HMO. Both models claim to be able to reduce healthcare costs by providing more care through earlier intervention, or through preventive screenings. I have not been able to find any definitive proof that the Medical Home model actually reduces healthcare costs. History has shown that the only way that costs can be reduced is by limiting medical care for everyone involved.
How does the Medical Home attract physicians to the group? Medical Homes promise the doctor a reduced patient load and longer appointment times per patient. They promise a less stressful practice environment, better practice management, and better medical outcomes belonging to the Home. It may mean that the doctor can practice medicine to help patients rather than run a business. To the specialists, the Medical Home promises to provide a better practice environment, healthier patients, and better outcomes. As a doctor, this promise is very attractive, though I find it hard to see how the income can be maintained.
So, what does this mean to the doctor in private practice? If you wish to remain in private practice it may mean more patients because the Medical Home promises its doctors that they will have a smaller patient load. I have to believe that these extra patients will need a primary doctor. If you agree that a Medical home is not much different than an HMO, then you should already know that many enrollees become dissatisfied over time and look for healthcare outside the organization. Another possibility is that the Medical Home model doesn't have enough revenue to sustain the Home and it will dissolve due to financial reasons, or the Medical Home administrators will need to cut back medical treatment expenses to remain solvent. No matter how rosy the promises, there is no way that the Medical Home can increase medical care while reducing costs without rationing care. I cannot believe that adding another layer of management to reduce costs while adding nothing to the medical treatment side of the business can reduce costs. Medical Homes and HMO's operate under the false premise is that there is massive waste or fraud under within the current medical system. I know in my practice we don't have the luxury of any financial waste, and I can assure you there is no fraud.
As a doctor in private practice, we would like your opinion on the viability of the Medical Home concept. Does it look like an attractive alternative with the new Healthcare reform taking effect in a couple of years? Let us know your opinion by commenting on this article.
One more thought: The fact that President Obama thinks the Medical Home is a good idea, should make you seriously consider the ramifications of such an idea.
