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On Medical and Other Patient-Centric Specialty Homes

15 Responses

1. Ted, on May 15, 2009 at 10:01 AM said:

   Dr. Marcinko,

   Your thoughts above are good, as well as pragmatic. However, perhaps we should consider the reasons why medical homes might be needed; although not necessarily succeed:

   1. Primary care physicians are underpaid. This was partially caused by the AMA CPT® coding committee which is top heavy with medical specialists.

   2. There is a shortage of primary care physicians, as a result of the underpayment noted above. This enhances the value and salary of PAs, nurse practitioner’s, DNPs and other physician extenders.

   3. Health insurance pays for real visits, as opposed to virtual ones, and medicine is decidedly procedurally based and focused on face to face [F2F] office visits.

   4. Finally, the population is aging with an increasing number of chronic conditions, and age-related medical issues. Caring for these patients is not glamorous or challenging. It is needed however, and labor intensive. It is the stuff of real grassroots medicine.

   Therefore, if any type of healthcare reform is to be achieved, it will first be by addressing these issues rather than spending billions of dollars for HIT. The medical home concept may be a good place to start for certain patient cohorts.

   Best
   Ted
   Baltimore, Maryland

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2. Hope, on May 15, 2009 at 10:06 AM said:

   Ted,

   You are correct, of course. The “medical home” concept may indeed be a good idea for older baby boomers and stable patient populations. At least, that is, for those patients who are merely “wearing-out”; rather than in need of acute or emergent care.

   Thanks for your input.

   Hope R. Hetico; RN, MHA
   [Managing Editor]

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3. Sanford, on May 15, 2009 at 1:05 PM said:

   Ted, Hope and Dr. Marcinko

   The firm http://www.TransforMed.com strongly believes that a positive future for primary care practices, family medicine practices — and the health of the patients they serve — can be achieved in part, through transformative practice redesign; also known as medical homes.

   I urge all ME-P readrs to visit them for more information.

   Sandy

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4. Dr. Grant, on June 2, 2009 at 8:05 PM said:

   With all due respect to David Kibbe MD, and Joseph C. Kvedar MD, is there any real evidence on the effectiveness of “medical homes”?

   Best
   Dr. Grant

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5. Brian J. Knabe, MD, on August 31, 2009 at 6:52 AM said:

   On Medical Homes

   It seems that the “medical home” concept is an attempt to justify higher payment for something that good primary care doctors should already be doing – coordinating care for a patient population. There are many primary care physicians who already perform these functions. If re-naming these functions would help employers and insurers to develop a greater understanding and appreciation for the role of primary care physicians, then maybe it will be helpful. The bottom line, however, is that the underpayment of primary care physicians must be corrected.

   I agree that patient mobility is a significant impediment to the medical home concept. Not only do patients frequently change physicians and geographic locations, they also change employers with increasing frequency. Measuring the benefits of the medical home will be difficult, as the benefits of improved care are often not evident for years or even decades. With the short attention span of corporate America, I will be surprised if employers are willing to pay for such a long-term investment in the health of their employees.

   Brian J. Knabe; MD

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6. Barbara, on September 2, 2009 at 11:01 PM said:

   Dr. Knabe,

   Thanks for your comments.

   Did you know that according to this article, the patient-centered medical home model is looking “sexier” by the minute, with studies increasingly suggesting that it works well on financial and clinical grounds.

   Now, after visiting your Savant website, I thought you might like to have a look and opine as a financial advisor and physician.

   http://www.fiercehealthfinance.com/story/study-medical-homes-boost-quality-cut-costs/2009-09-01?utm_medium=nl&utm_source=internal

   For me unfortunately, when public policy is described as being “sexy”, its time to run.
   Any other thoughts? And, I tend to think more like you and Dr. Marcinko, than not.

   Barbara

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7. Hope Hetico RN, MHA, on June 3, 2010 at 7:55 PM said:

   Medical home program leads to ‘significant’ cost savings, fewer hospitalizations

   http://www.fiercehealthcare.com/story/medical-home-program-leads-significant-cost-savings-fewer-hospitalizations/2010-05-05#axzz0pkK7yXGx

   Those who’ve experienced the medical home model describe it as modernized Marcus Welby care. Physicians work closely with a more manageable number of patients and conduct unrushed, same-day visits, sometimes even at patients’ homes.

   http://www.fiercepracticemanagement.com/story/pulling-back-curtains-medical-home/2010-06-01?utm_medium=nl&utm_source=internal#axzz0pkKK2WCO

   But; rather than going it alone, medical home docs have the support of powerful technology systems and coordinated medical teams to help keep patients healthy and out of the hospital.

   Still, the jury is “out” on this new healthcare business model; so please opine.

   Hope Hetico RN, MHA
   [Managing Editor]
   http://www.BusinessofMedicalPractice.com

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8. Kerry, on June 10, 2010 at 11:21 AM said:

   Medical Homes? … Not so Fast!

   The first national medical home demonstration has come to a close, and the 36 practices that put two years into transforming toward the business model delivered somewhat discouraging news.

   http://www.fiercepracticemanagement.com/story/first-national-medical-home-pilot-yields-lessons-future/2010-06-08?utm_medium=nl&utm_source=internal

   So, perhaps Dr. Knabe is correct about the futility of the medical home model. Is this concept just another failed theoretical machination; or a real business breakthrough?

   Kerry

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9. Clare, on June 12, 2010 at 5:38 PM said:

   Doctors on the Move

   The three-year average of physicians who moved to a new location or practice, retired, or passed away is 15.2 percent, according to a new report called “Physicians on the Move”, which reveals the rate of change for office-based physicians by practice specialty.

   The report, released by SK&A, a provider of healthcare information solutions and research, shows that such changes create obstacles in maintaining quality physician-targeting databases and lists necessary to execute high-performing sales, marketing and market research initiatives.

   http://healthcarefinancenews.com/news/study-more-15-percent-physicians-move-annually

   I agree with Dr. Knabe and Marcinko. So much for the medical home concept; when the docs themselves seem to be vagabonds; along with an increasing mobile society!

   Clare

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10. Frank, on July 24, 2010 at 1:46 PM said:

    According to Dr. Terry McGeeney, a primary-care physician and chief executive of TransforMED, the nonprofit medical home consultancy that partnered with the American Academy of Family Physicians to publish last month’s report, told the New York Times.

    “Patient-centered medical homes are a massive paradigm shift in how primary-care practices function.” As one of the first national studies of patient-centered medical homes, “we were starting at ground zero, and we weren’t aware of what we needed to do other than support the physicians’ personal motivation.”

    But, do you really believe this is a massive paradigm shift? Or, just a migration back to the way primary care used – and ought – to be, much like Dr. Knabe opines.

    Frank

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11. Ann Miller RN MHA, on September 5, 2010 at 12:49 AM said:

    Medical Homes

    More on the “medical home” business model of healthcare delivery:

    Click to access emerging.pdf

    By Health Capital Consultants, LLC

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12. Chad, on March 6, 2012 at 7:42 PM said:

    Patient-centered care ‘flawed’ with consumer focus

    Despite the trend in the catchphrase, “patient-centered care” is a flawed way of putting it, wrote Charles L. Bardes of New York’s Weill Cornell Medical College in a New England Journal of Medicine (NEJM) article, just published Thursday.

    http://www.nejm.org/doi/full/10.1056/NEJMp1200070

    Any thoughts?

    Chad

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13. Harley, on March 21, 2012 at 4:16 PM said:

    Medical home cost savings questioned?

    The medical homes, a concept of fortifying primary care mainly for Medicaid enrollees in order to improve their health and returns on dollars spent, have come under fire in recent studies.

    Here is a Stateline Health News report.

    http://stateline.org/live/details/story?contentId=638995

    Harley

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14. Dr. David Edward Marcinko MBA CMP™, on October 16, 2012 at 6:36 PM said:

    What Is A PCMH, Anyway?

    In broad strokes, for 2012-13, the historical PCMH is an organized system of care for delivering proactive and comprehensive primary care at the individual office practice level.

    The first iteration of the PCMH was developed by the American Academy of Pediatrics (AAP) all the way back in 1967, and the AAP then expanded the scope of this care model in a policy statement in 2002.

    The American Academy of Family Practice (AAFP) created its own PCMH model in 2004, and the American College of Physicians piled on with its version in 2006.

    Other organizations have followed suit with their own PCMH specifications, including payers and the National Committee for Quality Assurance (NCQA).

    Although there are some differences between these organizations’ PCMH programs, they generally have a common set of goals, which are of interest to primary care physicians and the patients they serve:

    • Provide Enhanced Access and Continuity
    • Identify and Manage Patient Populations
    • Plan and Manage Care
    • Encourage Self-Care and Community Support
    • Track and Coordinate Care
    • Measure and Improve Performance

    Dr. David Edward Marcinko; MBA, CMP™

    [Publisher-in-Chief]

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15. Ann Miller RN MHA, on November 28, 2016 at 7:24 PM said:

    Medication Adherence is 2.2% Higher In Medical Homes

    The Annals of Internal Medicine recently published a retrospective study on medical homes and medication adherence. Here are some key findings from the report:

    • 5.9% of patients in the study received care in patient-centered medical homes.
    • The average rate of adherence was 64% among medical home patients.
    • The medication adherence rate was 59% among patients in the control group.
    • Medication adherence was significantly higher in medical homes overall (2.2%).
    • Adherence was 3% higher for diabetic medical home patients vs control patients.
    • Hypertensive patients had 3.2% better adherence than the control group.

    Source: Annals of Internal Medicine, November 15, 2016

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