Will the Patient-Centered Medical Home save primary care?

Jaan Sidorov at the Disease Management Care Blog isn’t convinced:

There are no surveys of what rank and file community-based primary care physicians actually think about the medical home. We don’t know how well it will address the physicians’ lifestyle concerns or their income expectations.

And just what is it about the medical home that will fix these problems? Just because there is a medical home doesn’t mean high cost radiology services will not continue to come under preauthorization, that drug formularies will not put continue to put certain medications out of reach, that restrictive physician networks won’t be used or that managed care organizations won’t continue to bluntly prod physicians to achieve HEDIS benchmarks. Keeping patients away from the emergency room or the hospital requires a zealous amount of hustle that goes well beyond the 8-5 business day.

The DMCB suspects the support of the rank and file physicians for the medical home is being overestimated.

I tend to agree.  From what I’ve read about the medical home concept, once the jargon is stripped away it sounds suspiciously like what primary care doctors are already doing or at least trying to do.  If we want everyone to have a “medical home,” we’re going to have to stop paying family and internal medicine docs so little money for the considerable amount of time and effort they put into their jobs.

I suspect that is what will eventually happen, although I am a doubtful that the medical home model will be the catalyst.  A more likely incentive for the industry to finally recognize the value of primary care will be the massive influx over the next several years of Baby Boomers into Medicare.  Guess what, folks?  There isn’t going to be a correspondingly massive influx of medical students into primary care.  In fact, there is going to be an exodus of primary care physicians as they retire or cut back on the number of patients they see.  And those of us who remain will not all be accepting Medicare.  And when the tipping point is reached and the health care system finally cries “Uncle!” and agrees to start properly reimbursing primary care docs, there isn’t going to be some vast repository of FP and IM docs who have been sitting around waiting to be called up.  It’ll take quite a number of years to “re-primary care doctorize” American medicine.


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