Imagine the average patient with a case of acute bronchitis that worsens dramatically over a holiday weekend. According to a recent Commonwealth Fund survey, more than half of US primary care physicians do not offer after-hours care.[1] So, how many treatment options are there other than the emergency room?
While Americans may not be familiar with the term “medical home,” they know when they don't have a primary care practice that provides accessible, continuous, and coordinated care.
There are significant challenges to realizing the promise of medical homes with these characteristics. They include:
People lacking insurance and not being able to find a regular doctor
People switching practices due to job changes, relocations, or changes in insurers
Physicians not getting reimbursed for services related to coordination of care with other physicians, for providing consultations via email, linking patients with community services, or offering after-hours care.[2]
Today, only a small number of American medical graduates are entering primary care fields, and the physicians, nurses, and physicians' assistants who are in primary care have not necessarily gotten sufficient training to provide comprehensive medical home services.
There is good evidence from the US and elsewhere that better primary care services are associated with better patient outcomes and with lower costs. So, I think it's critical to address how to provide better primary care in this country.
The Commonwealth Fund is supporting efforts that will measure how well medical homes can affect patient experience, health outcomes, and health system performance. And recent federal legislation requires the Centers for Medicare and Medicaid Services to develop a demonstration project around medical homes, including new methods of compensation. Such research will help the United States take an important step toward a more patient-centered, primary-care-oriented healthcare system.[3]
Acting on this evidence, insurers should cover comprehensive primary care services. And when they do, more physicians now in training should choose to practice primary care.
That's my opinion. I'm Dr. Steve Schoenbaum, Executive Vice President for Programs at The Commonwealth Fund.
Footnotes
Readers are encouraged to respond to the author at scs@cmwf.org or to Paul Blumenthal, MD, Deputy Editor of MedGenMed, for the editor's eyes only or for possible publication via email: pblumen@stanford.edu
References
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- 2.Goroll AH, Berenson RA, Schoenbaum SC, Gardner LB. Fundamental reform of payment for adult primary care: comprehensive payment for comprehensive care. J Gen Intern Med. 2007 doi: 10.1007/s11606-006-0083-2. Jan 9:[Epub ahead of print]. Available at: http://www.springerlink.com/content/x864841076775u6p/ (subscription required) [DOI] [PMC free article] [PubMed] [Google Scholar]
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