Medical Homes and Quality

Medical Homes.  Patient Satisfaction Scores.  Quality.  All bullshit terms that are have been fabricated, abused, prostituted and co-opted.   And news studies show they may not even relate or effect each other.  One study in the journal Health Services Research asked 393 physician practices whether they implemented medical-home elements such as team-based care, electronic health records, disease registries, clinical decision support, quality measurement, patient reminders, email access and group visits. Then they surveyed 1,304 patients who received care at those clinics about their experience during the last six months. What did they find, you ask?  Amazingly enough, there was no association between a clinic’s use of patient-centered medical home processes and patients’ satisfaction with care.  Hmmmm.  That is weird?  In fact, the lack of improvement in patient experience remained even after controlling for characteristics of the clinics and patients that might have affected the results.  Crazy, right? Even better, in a recent Health Affairs study of 40 Los Angeles-area community health centers, it was found that those that had implemented more medical-home processes did not fare better on quality metrics in caring for patients with diabetes.   That shouldn’t matter because better quality metrics may not help the overall care of the patient anyway.  So what did we learn here?  Absolutely nothing other than these studies will be ignored by the government, our physician representatives and organizations, insurance companies and hospitals.    Why?  Because they have all bought into this unproven crap for different self-serving reasons.  And healthcare will suffer.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  2 comments for “Medical Homes and Quality

  1. July 11, 2012 at 9:56 am

    “Health care” won’t suffer at all. MEDICAL care will suffer. “Health care” is the business model that prioritizes scarce economic resources. Medical care is the clinical model that prioritizes considerations of an individual’s scarce mortality and functioning – not an organization’s or political entity’s. Likely you’re going to think this is theoretical bullshit; I understand. But it is exactly because Us and Them have two different visions for the enterprise, therefore two different missions, processes, values, yadayada, that Us, and Them, screw each other. And themselves.

    Health care will always make jobs (even “important” jobs) for people to come up with fixes and measurements and reports specific to a commercial model. Nothing unusual about that. It will perpetuate itself. CEOs want to drive nice cars. Docs and nurses and such will come up with stuff consistent with their model. Nothing unusual about that. We want to drive nice cars. After all, aren’t we all God-damned entitled?

    Just, don’t mix them up. Or, if you do, don’t expect a happy marriage. Unless you want to sit in the Doctors’ Lounge and play “Ain’t It Awful?” while you secretly work on that executive MBA. By the way, why are you working that degree?

    Look, I don’t mean to be more of cortico-rectal fistula than any other (retired) solo practitioner can be. Docs – whether we call ourselves “servants” or “surgeons” – coulda/shoulda/woulda seen the hurricane coming a long time ago. They wanted to play The Game of Thrones. They gave up the moral high ground, both in calling out society and calling out each other. They gave up the Profession, Collegiality (Ted’s right about that), and blessed sodality. (Like, when I access “The Dying of the Light” blog, right under its heartfelt conviction is a picture of a vapid babe, hopefully not some doc’s daughter, smugly ready to answer The Big Question, “Why Did She Choose Robotic Surgery at St Mary’s Hospital?” So… this ain’t irony?)

    What did they expect?

    More importantly, Hamlet, what are you going to do about it? O cursed spite, that ever you were born to set it right.


    David Block MD

    PS: Hint: the answer is not ROBOTIC surgery. Or more EMGs. Or even Botox. Whatever.

  2. July 8, 2012 at 9:45 pm

    All correct, because too many physicians have for too long, believed that government should be involved in health care.

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