4 Reasons PCMH Principles Aren't Going Away

Philip Betbeze, for HealthLeaders Media , March 7, 2014

So, like other highly touted panaceas that have attempted to rein in runaway healthcare costs and address dubious quality only to fall far short, does the PCMH movement's hype far exceed its results?

Perhaps. In this limited sample size over three years, it appears so. But before we file the designation under "Bad Ideas," let's address what the report leaves out.

1. The sample size was too small.

Analyzing the cost and quality results from 120,000 people over three years is a big task, but perhaps it's not big enough. After all, this report analyzed only a small piece of the PCMH-designated universe in a very limited geographic area.

Other studies have come to strikingly different conclusions. This report by the Patient-Centered Primary Care Collaborative, admittedly an advocacy organization, cites several PCMH initiatives that have gone on for much longer than three years, and that have saved significant sums (see page 9) in costs, and have had marked positive effects on utilization, quality and outcomes.

Health plans and the government are big believers, and since they pay the freight of healthcare services, there's no sign they are doing anything but increasing their investment in the PCMH structure.

2. Certification is only one of the first steps.

The fact is that Patient-Centered Medical Home certification is far from a guarantee that an organization is taking the necessary steps to both improve quality and cut healthcare spending. What it does do is assure that they have the tools to better coordinate care, and that staff at a particular practice have been trained to serve as the center of care for their patients.

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2 comments on "4 Reasons PCMH Principles Aren't Going Away"

Arun K. Potdar (3/9/2014 at 4:02 PM)
The analysis of the analysis is excellent and it corrosponds with my own life experiences working in the Medical Practice Management areas. However there is another angle that needs to be discussed which is touched briefly in this report. That is the area of Pardigm Shift happening in the health care provider industry. I found lot of resistance from the clinicians whenever a new approach to practice management was discussed. Similarly, allied trades supporting the practice management like PA and Practice managers are not prepared for facing the PCMH during their training phases. Clinicians also do not see a buy-in values in operating in these environments and as you mentioned, ' taking responsibility of a patient beyond the practice premises is still not accepted as a duty but looked upon as added burden because of lack of incentives that can be seen immediately as one sees in a FFS arrangement. If this Paradigm shift has to succeed then the seeds must be sowed in the key operator's training areas at their schools and that includes Medical and other clinically allied educational institutes. Existing practices have a major attitude problem where getting a 'Certificate' is drilled in the psyche of the management as a goal that ends with a wall hanging of said certificate. This is the hard part of conversion of mindsets because clinicians themselves do not have a full buy -in of PCMH principles. Thanks for the meaningful insight.

Jeff Angel (3/7/2014 at 2:10 PM)
Phillip, I'm glad we specialists don't practice medicine the way consultants and most insurance-paid think-tanks and masters of public health officials take these studies that dispute your efforts!!Its a disgrace to the medical profession to discount the data!!!Common sense? and you demonize specialists every day, when we practice gold standard medicine? Its sickening to be on my side of your game, yes game. Profiteers and carpetbaggers(consultants, attorneys, managers) want a piece of a small pie[INVALID]-thats what is driving this. Medical inflation is very low over past few years my man.[INVALID]-demographics of population, pure and simple is problem. We have to ration care. Medical homes by primary care docs who don't have the depth of knowledge to properly [INVALID] screenings even for simple musculoskeletal problems or Ob, or gi, etc, etc. is a non-winner except for taking care of chronic conditions. WAKE UP, you are wrong, and now wanting to cry that data proves it!! A sore throat doesn't need a team!!!!!!And a fractured femur or torn cuff doesn't need months of therapy!!!!! The most efficient care is precise diagnosis, with precise speciacilized care when needed. It costs a lot. Rationing end of life care and tiered treatments based on ones production in society is answer. LOL, your article is repulsive from a scientist and doctor who has spent 30 years practicing on data!!!!!!!!!!!!!!!!!!!!!!




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