Medical Homes Study Doesn’t Pass the Smell Test
A North Carolina study of Patient-Centered Medical Homes reports a huge $300-million in savings. Here’s what’s wrong with the study, according to Al Lewis:
(1) Every element of resource use declined. People have to be getting their care from somewhere, but inpatient, ER, outpatient, physician, drug, and other expenses somehow all declined vs. trend.
(2) The decline in physician practice expense is especially counterintuitive: Why are the doctors so supportive if they are working harder but making less money?
(3) Even though somehow savings were shown in physician expense, per capita doctor visits did indeed increase. More concerning was that specialist visits –which are supposed to decline in a PCMH model – also increased.
(4) Inpatient expense fell 47%. This was achieved despite the fact that all the AHRQ’s “Ambulatory Care –Sensitive Conditions” total to about 20% of admissions in most populations.
(5) The evaluators (William M. Mercer) are on record as saying that “choice [emphasis mine] of trend has a large impact on estimates of financial savings.” Perhaps it is possible that Mercer, having given themselves this latitude, “chose” a trend that would make the study look good.
Those observations merely suggest that the study was done wrong.
The author made another statement:
He goes on to explain the whole concept of Patient Centered Medical Homes is to better manage chronic disease. The mere fact they study wasn’t having a huge impact on chronic disease should have been reason to investigate further.
Don’t there results also support the hypothesis that people hated it so much that they went elsewhere for care even if they had to pay out-of-pocket?
Darn. One more Obama Care reform idea bites the dust.
Glad to see you staying on top of these things.
Not surprised.