The Medical Home Gains Momentum: Could a team-based model work for otolaryngology?

The patient-centered medical home’s star appears to be rising. Thirty-eight states are testing this model of care in some way, according to the National Academy for State Health Policy. The federal health system reform law, passed this spring, includes several provisions encouraging the concept.

So what is a patient-centered medical home (PCMH), and what does it mean for otolaryngologists?

Redefining the Concept

The American College of Physicians (ACP) defines the PCMH as a team-based model of care led by a personal physician who provides continuous, coordinated care throughout a patient’s lifetime to maximize health outcomes. The practice is responsible for providing for all of a patient’s health care needs or appropriately arranging care with other qualified professionals.

The PCMH model was developed by primary care physician groups, which agreed on unified principles in 2007. The focus is on primary care practices using the model to improve patients’ health.

The challenge will be to distinguish medical homes from the strict health maintenance organization (HMO) model of the 1990s, which proved unpopular with both patients and specialists because it made primary care doctors gatekeepers of referrals, said Mark C. Weissler, MD, FACS, an otolaryngologist and member of the American College of Surgeons Board of Regents, speaking on his own behalf. If public or private payers decide to capitate medical home payments, the incentive could be to limit referrals, he explained.

Under the PCMH model, primary care doctors are not gatekeepers, said Roland A. Goertz, MD, MBA, president of the American Academy of Family Physicians (AAFP). The concept’s focus on care coordination and quality improvement should result in better communication and stronger relationships between primary care doctors and specialists, he said. “The public should demand it,” he added.

Others worry that any extra pay to compensate primary care physicians for medical home costs, such as the effort involved in coordinating care, might be taken from funds that would otherwise go to specialists. Sixteen surgical societies, including the American Academy of Otolaryngology-Head and Neck Surgery, argued against this notion in their 2009 agenda for Medicare payment reform.