Medical Homes vs. Direct Service Docs

The term "medical home" conjures up HMO-type medical care to many. Ironically, the medical practice might turn out to be similar to what is being done by direct service (concierge) doctors – who refuse to take third-party payment. Here is what Group Health Cooperative (an HMO in Seattle) is doing:

  • The number of patients each primary care doctor sees was reduced from 2,300 to 1,800; appointment times were increased from 20 to 30 minutes; primary care staff was increased by 30%; and there was increased use of telephone, e-mail and electronic medical records.
  • Result: 29% fewer emergency room visits and 11% fewer inpatient hospital stays.
  • Bottom line: The greater investment in primary care pays for itself in lower downstream utilization.

Alert readers will note the similarities between this description and my description of the free market, direct service doctors.

Comments (5)

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  1. Linda Gorman says:

    Just to clarify: “medical home” as used by those in favor of more government control over health care is a synonym for low level gatekeeper. It has nothing whatsoever to do with physicians who want to provide top-notch patient care and so opt out of third party payment.

    As envisoned by ObamaCare reformers, you medical home wil not even be a physician. It will be a clinic where you have to jump through a bunch of cost-saving hoops before being referred to a physician assuming that there are enough referral slots left.

    The medical home idea has been pushed by the American Academy of Pediatrics as a way to boost reimbursements. It has absolutely no empirical support.

    The service provided by ObamaCare clinics can be glimpsed by looking at Medicaid, the doctor shortage in Canada, the NHS, and some US HMOs. It is worlds away from the service envisioned by the average physician who currently switches to a cash only practice.

    The proper response to anyone who wants to shove you into a “medical home” is to point out that many households see a pediatrician, an OBGYN, an internist, a dentist, and an orthodontist. They don’t need a medical home, as they already have several, and they certainly don’t need a government official putting a poorly trained gatekeeper between them and their medical care.

  2. Joe S. says:

    Good post, Linda.

  3. Tom H. says:

    I think linda is right. It’s another way to ration care.

  4. Bret says:


  5. John R. Graham says:

    I have followed the Patient Centered Primary Care Collaborative (PCPCC) and I think it started out ok. It was started by the ERISA Industry Committee based on positive experience with some large self-insured employers. The problem is that they think it is easily scalable to the general population.

    Once they brought the doctors on board it just became a revenue-maximizing effort for primary-care docs and descended into rent-seeking. The latest is a letter to the House barons requesting funding in their health “deform” bill for pilot projects for medical homes in Medicare!

    The specialists, of course, are realizing that this will mean less money for them and resisting. I suppose the result will be yet another CPT code to be negotiated ad nauseum in eternity.