The promise of the medical home

The moment is right for the concept of a medical home, and that means it's time to give serious attention to how physicians will be paid for this more comprehensive care.

Posted Dec. 8, 2008.

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The patient-centered medical home is a concept gaining new, long-overdue attention from policymakers as one promising way to improve health care quality and promote efficient care.

Organized medicine wants to make sure any medical home model considered in the halls of Congress or in insurers' boardrooms is truly designed to help physicians improve their patients' health. That's why, at its Interim Meeting in Orlando, Fla., in November, the American Medical Association House of Delegates voted to join four other members of organized medicine to adopt joint principles on the patient-centered medical home. By signing onto the well-crafted standards with the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians and the American Osteopathic Assn., the AMA will help keep physicians out in front of this issue.

Many doctors want to do the things that would qualify them as a medical home. Many want to spend more time coordinating the care of their patients. They want to work alongside each patient to develop a comprehensive treatment plan. They want to contact the patients' other doctors to make sure all of their care fits into that plan. Their staff wants to call patients to check on them and make sure they're following doctors' orders.

But the payment side of the equation has not matched that commitment and has made it impossible for most to adopt that structure. Medicare and many insurers still don't pay doctors or their staffs for the extra time and resources required to run a medical home.

The result of this is that too many practices just aren't able to coordinate care as much as they really want to. Experts agree that the resulting system is fragmented and inefficient -- and patients, physicians and payers all suffer the consequences.

That can -- and should -- change. With lawmakers fired up about the prospects of health system reform next year, the patient-centered medical home can become one powerful tool for addressing the system's woes. Also, starting in 2010, Medicare will test how paying more to selected practices that become approved medical homes can improve care. The demonstration will use payment guidelines from the AMA-convened Relative Value Scale Update Committee.

If lawmakers and insurers follow the principles from the growing list of organized medicine backers, they will pay more to practices that go the extra mile as medical homes. Practices also will share in any savings that result from the more coordinated, higher quality, more efficient care.

Physicians will have responsibilities, too. They must promise to support a continuous care plan, more closely follow evidence-based medicine, seek patient feedback and significantly expand patient access to office services.

Many questions remain about how to structure a workable patient-centered medical home system. That's why the AMA House of Delegates was wise to refer some of the tougher questions about how the payments would work to the Board of Trustees for further review. Physicians need to consider carefully where the additional dollars should come from and, looking beyond primary care, what specialty practices can serve as medical homes. The AMA Council on Medical Service also will report on some of these payment issues at the Annual Meeting in June 2009.

But working out these details should not stop physicians from making progress on this issue with policymakers. The medical home concept alone is not enough to get the health system to where it needs to be. If policymakers consider the option and follow the sensible principles now embraced by the AMA, however, they will be on the right track.

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