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

by Geri Aston •

2008: The National Committee for Quality Assurance begins offering a PCMH recognition program.

March 2010: The Patient Protection and Affordable Care Act becomes law. It includes provisions promoting medical homes.

June 2010:The federal government invites states to apply for a multi-payer primary care practice demonstration to test medical homes.

Sources: AAFP, “The Patient Centered Medical Home: History, Seven Core Features, Evidence and Transformational Change,” Robert Graham Center, November 2007; “History of the Medical Home Concept,” Pediatrics, May 2004

Primary care organizations do not advocate for extra medical home payments to come from other doctors’ pay, noted Dr. Goertz. Likewise, a Medicare payment bump for pediatric medical homes at the expense of pediatric subspecialists would be a move in the wrong direction, said an American Academy of Pediatrics (AAP) spokesperson.

An article in Chest noted that funds to pay for expanded fees for medical homes could be obtained over time through cost savings resulting from the way the PCMH model increases primary care access, coordinates care, provides evidence-based medicine and manages chronic illnesses (2010;137(1):200-204). A December 2007 Commonwealth Fund report estimated that $194 billion could be saved over 10 years by assigning each Medicare fee-for-service beneficiary a medical home.

The 2009 surgical specialty society agenda also stated that specialists should be able to run medical homes. The medical home principles adopted by the primary care associations are specialty neutral.

The new health reform law includes provisions that call on the Department of Health and Human Services to issue grants or enter contracts to foster establishment of medical homes. The act defines the medical home as a mode of care that includes personal physicians but does not elaborate on what a personal physician is.

Practical Implications

Do specialists want to redesign their practices as medical homes? In a survey of 373 single-specialty cardiology, endocrinology and pulmonology practice leaders, 81 percent of respondents said their physicians serve as primary care doctors for 10 percent or fewer of their patients. Just 2.7 percent said doctors in their practice fill that role for more than 50 percent of their patients, wrote the researchers who conducted the survey, which was reported in The New England Journal of Medicine (2010;362:1555-1558).

“Specialist-based medical homes should be required to meet the same standards as primary care-based medical homes, including the requirements for providing first-contact, continuous and comprehensive care, and for using systematic processes to improve the health of the practice’s patients,” the authors stated.