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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Thursday, August 16, 2007

    Home, Sweet Home: Grunt Doc notes this statement by the American Academy of Pediatrics and gets the willies at the phrase "medical home." One of his commentors asks "What the f*ck is a 'medical home???' "

    And well he might ask. Here's one definition:

    In the advanced medical home model, patients will have a personal physician working with a team of healthcare professionals in a practice that is organized according to the principles of the advanced medical home. For most patients the personal physician would most appropriately be a primary care physician, but it could be a specialist or subspecialist for patients requiring on-going care for certain conditions, e.g., severe asthma, complex diabetes, complicated cardiovascular disease, rheumatologic disorders, and malignancies. Primary care physicians are defined as physicians who are trained to provide first contact, continuous, and comprehensive care (27). Principal care, that is, the predominant source of care for a patient based on his or her needs, can be provided by a primary care physician or medical specialist. In most cases, primary care physicians, with their office care team, are ideally suited to provide principal care and be a patient’s care coordinator – a personal physician, in the advanced medical home model. However, a medical specialist with his or her office care team can fulfill the role of personal physician as defined in this paper if he or she so chooses. Rather than being a “gatekeeper” who restricts patient access to services, a personal physician leverages the key attributes of the advanced medical home to coordinate and facilitate the care of patients and is directly accountable to each patient. Personal physicians advocate for and provide guidance to patients and their families as they negotiate the complex health care system.

    And a simpler explanation:

    The American Academy of Pediatrics describes the medical home as a model of delivering primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care.

    In short, "medical home" is the newest craze in medical euphemisms. It's what used to be called a "primary care provider" in the heyday of HMO's. But the phrase "primary care provider" has gotten a little ambiguous what with retail clinics staffed by nurses claiming to be primary care providers and what not. Also, the HMO's tainted the "primary care providers" with the tag of "gatekeepers." This gave the impression that the doctors who were supposed to have the patients' best interest in mind at all times were in the business of keeping said patients away from needed services.

    The "medical home" sounds so much cozier, doesn't it? A place where mamma and pappa doctor will keep you healthy and clean. Personally, I prefer the term "personal physician" to "medical home" but I understand why the term has been adopted as a marketing ploy to get the attention of third party payers. It's an attempt to make it clear to these keepers of the purse that there's a value to the continuity of care offered by a personal physician as opposed to the disjointed care of multiple retail clinic visits and non-emergent emergency room visits. (And I'm sure GruntDoc would agree that the non-emergent cases are better seen in the office than in the emergency room.)

    The movement is afoot, and enjoying some legislative success. Rumor has it that United Healthcare is poised to support the concept as well. We'll see how it all works out. Most of these types of initiatives are started by doctors in the hopes of improving reimbursement, but they rarely work out that way.

    In the meantime count this physician as one who is content to just be a plain old family doctor.

    UPDATE: Roy Poses has more details on the United Healthcare angle at his blog. Including a link to this AAFP News item which explains the payment angle:

    "This is about physician payment reform and testing the patient-centered medical home model in the marketplace," said AAFP President Rick Kellerman, M.D., of Wichita, Kan.

    For some time, the Academy has urged payers and employers to implement pilot programs that would experiment with new payment strategies to reflect the value of primary care, said Kellerman.

    ....UnitedHealth Group will pay participating physician practices a monthly care-management fee based on projected savings for all patients that select a medical home. In addition, the company will share any excess savings that accrue from the pilot program with the physician practices and -- by way of premium reductions -- with employers.

    Color me skeptical. One of things that United Healthcare is doing is supplying a nurse advise line 24/7 and other disease management programs. This means that they will be spending money to provide things that physicians traditionally do as part of their ordinary fee. More money will be spent by adding another layer of people to do these things, not less.

    posted by Sydney on 8/16/2007 08:01:00 PM 2 comments


    Medical home = having a doctor who tries hard. Got it.

    By Blogger Allen, at 11:42 PM  

    There is a move afoot to pilot-test a version of this, with the help of everyone's favorite managed care organization, UnitedHealth. What has been published about how this will be done raises some disturbing questions. See this post on Health Care Renewal:

    By Blogger Roy M. Poses MD, at 11:11 AM  

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