Medical Homes Study Flawed
One idea being pushed by “reformers” is the notion of a “medical home.” But like a lot of swell ideas, the advocates tend to cherry pick the information that supports the idea and ignore anything that counters it. Buz Cooper, MD, of the University of Pennsylvania, reviewed articles recently published in Health Affairs and JAMA about Group Health’s version of a medical home. He says, “The big news is that costs for patients in their Medical Home were a full 2% lower than in conventional practices, hardly a great success — it wasn’t even statistically significant. But was even this small difference due to the Medical Home, or was it because Medical Home patients were less likely to consume care?”
The articles he references said that the study group and the control group were similar in age, sex and diagnosis, but they plumb forgot to compare the groups for health status, education, or income — which are the most important factors in determining outcomes. He also notes that patients dropped out of the pilot program at alarming rates. It started 2006 with 9,200 patients enrolled but ended 2009 with only 7,018.
Public health advocates like the concept of a medical home because it sounds so intuitively sensible. A home is where we seek solace after a long day; where our parents cared for us. But, as in life, some homes are better than others.
In the end, whether a medical home is a good idea will depend upon whether our primary care physician has the time and inclination to treat or coordinate all the medical needs of their patients.
At present, primary care is reimbursed at a lower rate than specialty care and there is virtually no reimbursement for coordinating the care patients receive from their (higher paid) specialists.
Thanks for posting this. We hear so much nonsense about medical homes. It’s just one more fad.
Health advocates like the concept of a “medical home” because ObamaCare subsidizes them. It is another characteristic of the practice of medicine focused on the needs of government instead of the needs of patients.
“What gets measured gets done,” so we can expect the medical journals to publish a lot more articles trumpeting this idea, as it becomes one of the few ways for medical practices to make money in the future.
I agree with Joe.