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ARRA and Payment Reform - Does Medical Home Fit The Bill?

April 21, 2009
by Joe Bormel
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We live in exciting times. I just finished reading this: No Direction Home: A Primary Care Physician Questions The Medical Home Model by Caroline Poplin. It was handed out at a meeting, with the following text marked up:

  • Patients with insurance can't find a primary care doctor
  • Internal Medicine residents are "fleeing the field" of primary care - only 2% are choosing primary care
  • Patient-centered medical home (PCMH) is "the answer" (it's the best alternative on the table to traditional FFS)
  • Electronic medical records (EMRs) are at its core
  • PCMH fails to address the real driver of cost problem - increased volume of expensive procedures, tests, imaging

At the AHIMA ICD-10 summit last week, I learned in detail that the change in disease classification (ICD-9 to 10), at a fifty thousand foot view, is really about payment reform in the U.S. Candidly, I was looking at the issue much more tactically and instrumentally. We were just changing coding systems. Kind of like moving to ASCII in the 1970s. For a summary and best links, see my post

"When in doubt, do the right thing."

This theme keeps developing ... everything is about structural changes to facilitate U.S. healthcare payment reform. A strategy to save Medicare.

At the end of the week, I attended our regional, monthly

HealthTech Net meeting. Since the 2008 election, this meeting has packed the board room, and we've begun video conferencing with the West Coast office (Washington, DC, and Silicon Valley.)

The topic last week was

Patient-Centered Medical Home. The story shared was our HCIT dream. Care is readily available and coordinated through information technology, including a PHR. The care process is measured; the right things are done and things are done right. Resources are more rationally used, and non-visit-based care is readily and appropriately available.

I'd like to end here, with a reference back to "No Direction Home," where Poplin urges caution about PCMH. I think she summarized it well here:

... today’s patients clearly want a personal physician, someone they trust, who knows and cares about them, understands their problems, and can guide them through the maze that is modern American health care. Indeed, a market has sprung up to serve such patients, called “boutique” or “concierge” medicine. However, these medical homes are expensive mansions, beyond the reach of all but a few.

I think that's right. What we want are affordable, patient-centered medical mansions. Can EMRs, payment reform and the structural changes necessary make those mansions possible, for the many?

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