Old-Fashioned Docs Inspire New ‘Medical Homes’
July 16, 2008 | General, Healthcare Debate
Will Giving Doctors More Money to Coordinate Care Pay Off?
By JULIE APPLEBY
July 14, 2008
States, the federal government and private insurers are experimenting with an idea to cut costs and make patients happier: Paying primary-care doctors extra money to oversee and coordinate patients’ care.
The pay boost rewards doctors who reshape their practices to recreate an era when a trusted family physician helped patients through hospitalizations, coordinated specialist care and provided routine screenings. Such efforts may save money by reducing hospitalizations, ER visits and disease.
Dubbed “medical homes,” the concept is a modern twist on an idea first promoted in the 1960s. Under most pilot projects being tested, primary-care doctors who have established medical homes will receive additional fees ranging from just a few dollars a month per patient to more than $35,000 a year per doctor from states, Medicare or other insurers.
Medicare this year will choose eight states to test whether paying primary-care doctors more per month to treat patients with chronic illnesses in medical home settings results in better care and lower costs than traditional practices.
The concept aims to change rushed doctor’s appointments and fragmented specialist care by creating patient care “teams,” which could include nurse practitioners, nutritionists or other medical staff. Medical homes also offer longer office hours, electronic medical records and same-day appointments.
The idea is that patients would turn to a trusted adviser, either the doctor or another team member, for preventive and routine care and rely on that person to help coordinate needed screenings, specialist visits and other care, says Terry McGeeney, head of TransforMED, a subsidiary of the American Academy of Family Physicians that helps doctors create such practices.
While health maintenance organizations and managed care companies aimed for such coordination, many didn’t pay doctors adequately for it, instead rewarding them financially for restricting care, says McGeeney. Under medical homes, he says, doctors won’t prevent patients from seeing specialists or ordering tests.
It’s not clear how well such plans will work. North Carolina saved $231 million in 2002-03 by setting up medical homes in its Medicaid program.
Joseph Antos, an economist at the conservative American Enterprise Institute, says no one argues with the goal, but: “If all we’re doing is rearranging the deck chairs on the medical Titanic, and spending more money, that’s clearly not something we want to do.”
The idea appeals to doctors such as Joseph Mambu, who set up his Pennsylvania practice as a medical home. They recreate “the old-fashioned doctor who has the time to get to know you,” he says. “This is our last, best hope to save primary care.”
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Comment by Tom July 16, 2008
Wonderful. It permits doctors to be real doctors for patients and no more third party (health plans) intervention. Here, the doctors will establish a better relationship and understanding of the patients (and their families). This is how you can effectively provide care especially for chronic diseases. Ultimately, the cost will only be a fraction of what we spend today.
By the way, are there any doctors in the country whom I can sign up with? I simply do not want to deal with health plans anymore.
Tom
Comment by Dementia Guide July 21, 2008
I think this is a very interesting concept and agree that if people are more comfortable with their doctor, they will be more willing to do check-ups, test, and listen to the advice from that doctor. I know for a fact that it was a pain when my grandma started having signs of dementia and our family had to switch to a new doctor for her because her older one transferred to another hospital.