In today's health care system, most of us spend little time with our primary-care physicians. Patients are sent to specialists for problems and chronic conditions, and unfortunately primary-care physicians rarely communicate with these specialists.
New York Times' Jane E. Brody shares that her "81-year-old friend with multiple health problems complained recently that she was seeing an orthopedist, a rheumatologist, an oncologist, an ophthalmologist and an endocrinologist but had no doctor to oversee and coordinate her overall care." Maybe her conditions are being addressed but where is the coordination? More importantly, who is taking care of the patient?
There have been numerous articles over the past week about a new approach to patient care called the medical home or the patient-centered medical home. Don't let the name confuse you – the approach has nothing to do with doctors making house calls. According to Catherine Arnst in Business Week's The Family Doctor: A Remedy for Health Care Costs?, "It's more like doctoring 1950s style, when a Marcus Welby figure handled all the family's medical needs. This time it's juiced up with medical technology."
Body explains the medical home in her article, A Personal, Coordinated Approach to Care,
…it is an approach in which each person has a primary care doctor who heads a team of professionals — perhaps including a physician assistant, a nurse practitioner, a dietitian, a social worker and a pharmacist — to provide round-the-clock access to care.
It is unlike managed care, in which primary doctors act as gatekeepers to specialists and the overriding goal is not managing care but managing costs. In a medical home, the family doctor helps patients get specialty care when they need it and, through electronic records, keeps careful track of treatments and informs specialists of the patients’ progress. The connections between the professionals who work on each case are seamless and convenient. Doctors and patients have easy access to medical information, and patients with chronic ailments are called regularly to reinforce treatment regimens and see how they are doing.
This is a team approach where nurses spend more time on the record keeping work that has generally been done by the doctor. This frees up the doctor's time to spend with patients discussing management of conditions and discussing cases with specialists and other members of the team.
According to Arnst, only 27% of physician practices currently qualify as medical homes, and only 17% of doctors offices have electronic medical record systems.
The medical home concept is a significant change, and one that doesn't currently sync with Medicare and insurers reimbursement policies. According to Arnst,
As sensible as this routine may sound, it goes against the grain of most primary-care practices. Medicare and other insurers pay doctors on a fee-for-service basis that rewards quantity of care over quality. There are no reimbursements for discussing diabetes management with a patient, say, or talking over a case with a specialist. "The main hurdle to getting the medical home accepted more widely is the lack of compensation for cognitive work," says Harvard Business professor Clayton M. Christensen, co-author of The Innovator's Prescription: A Disruptive Solution for Health Care.
The concept has the endorsement of 500 large employers including IBM as well as four medical societies, and most importantly, President Obama has said that any health care bill should "encourage and provide appropriate payment for providers who implement the medical-home model."
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