Old-Fashioned Docs Inspire New 'Medical Homes'
Will giving doctors more money to coordinate care pay off?
July 14, 2008— -- States, the federal government and private insurers are experimenting with an idea to cut costs and make patients happier: Paying primary-care doctors extra money to oversee and coordinate patients' care.
The pay boost rewards doctors who reshape their practices to recreate an era when a trusted family physician helped patients through hospitalizations, coordinated specialist care and provided routine screenings. Such efforts may save money by reducing hospitalizations, ER visits and disease.
Dubbed "medical homes," the concept is a modern twist on an idea first promoted in the 1960s. Under most pilot projects being tested, primary-care doctors who have established medical homes will receive additional fees — ranging from just a few dollars a month per patient to more than $35,000 a year per doctor — from states, Medicare or other insurers.
Medicare this year will choose eight states to test whether paying primary-care doctors more per month to treat patients with chronic illnesses in medical home settings results in better care and lower costs than traditional practices.
The concept aims to change rushed doctor's appointments and fragmented specialist care by creating patient care "teams," which could include nurse practitioners, nutritionists or other medical staff. Medical homes also offer longer office hours, electronic medical records and same-day appointments.
The idea is that patients would turn to a trusted adviser, either the doctor or another team member, for preventive and routine care — and rely on that person to help coordinate needed screenings, specialist visits and other care, says Terry McGeeney, head of TransforMED, a subsidiary of the American Academy of Family Physicians that helps doctors create such practices.
While health maintenance organizations and managed care companies aimed for such coordination, many didn't pay doctors adequately for it, instead rewarding them financially for restricting care, says McGeeney. Under medical homes, he says, doctors won't prevent patients from seeing specialists or ordering tests.
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