By John Ballard
Chris Flemming in Health Affairs makes several good points in two paragraphs worth reading.
Most primary care physicians see about 25 patients a day, Casalino said. A majority of these face-to-face visits are unnecessary, �but the only way to get paid is by doing these visits, so you just crank them out as fast as you can go.� He called this �hamster care� and said that every day during his twenty years of primary care practice was like �going to war.� As a primary care physician, you understand that things are not right, but you don�t have time to think about better approaches, �and even if you could it wouldn�t matter, because the way you are paid constrains what you can do.�
In an ideal world, physicians would see only about 8 to 10 patients a day face to face; they would spend the rest of their time �in email and phone communication with patients and their families, and other health care workers; coordinating care; thinking a little bit; and working with the practice staff to put all these nice patient-centered medical home concepts into action,� Casalino said. This transformation will only be possible if physicians are paid for these non-visit activities, but most current medical home demonstration projects �give little or no extra compensation for being a patient centered medical home. You still only get paid for the visits that you provide,� he pointed out. The patient-centered medical home �will not be a generalizable model in the United States unless the payment system is radically transformed.�
More at the link but that about covers it.
He's right.
There's an old management saying that if you want to get something done assign it to the busiest person you can find. It's just a matter of time but the changes he suggests will be forthcoming but not in some fee-for-service variant. I have confidence that those providers who figure out how to make it work will rise to the top, like cream rises to the surface of fresh whole milk.
The medical home model is neither new nor vague, but a living reality which has been in existence for decades, starting with pediatricians and family physicians in the late Sixties. It works with all patients for our best providers, delivering better care at lower costs. There is no good reason it can't work almost everywhere.
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