Friday, July 03, 2009

The family doctor: a remedy for healthcare costs?

The primary care doctor is gaining new respect in Washington.

Battles may be breaking out over the various healthcare bills emerging from Congress, but reformers agree that general practitioners should be given a central role in uniting the fragmented U.S. medical system.

This according to an article in BusinessWeek.

This vision has a name: the "patient-centered medical home." The "home" is the office of a primary care doctor where patients would go for most of their medical needs. This medical home may sound like the "gatekeeper" model of the 1990s, a managed-care creation that was all about holding down costs. But advocates say the new concept is designed to help patients, not insurers. 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 digital technology.

It also represents a way to streamline a disorganized and wasteful system that chews up a crippling 18% of the U.S. gross domestic product. That burden is felt particularly by private industry, which covers 60% of the nation's insured. Since most businesses try to ferret out waste and disorganization in their own operations, the medical home is a concept they can embrace in good conscience.

The current practice of medicine in the U.S. is a long way from this model.
  • Only 27% of physician practices come close to qualifying as a medical home;
  • Medicare and other insurers pay doctors on a fee-for-service basis that rewards quantity of care over quality; and
  • There are no reimbursements for discussing diabetes management with a patient or talking over a case with a specialist.
It is tough for many doctors to focus on coordinated care when there is no mechanism to pay them for their time. A nationwide switch to medical homes is also constrained by an extreme shortage of primary care physicians, again because of the economics. Medicare reimburses primary care at a lower rate than any other specialty, so only 17% of medical graduates choose to enter the field.

The efficiencies came from relying on a team approach, where nurses take on a lot of the record keeping once left to the doctor.

Click here to read the full BusinessWeek article and watch an interview with the author.

Is there an innovation that could make it feasible to have many more "patient-centered medical homes?”

Could companies and/or other organizations even sponsor them?

I welcome your comments.

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