Patient Centered Medical Homelessness

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So the big news out of JAMA was this study, which concluded:

A multipayer medical home pilot, in which participating practices adopted new structural capabilities and received NCQA certification, was associated with limited improvements in quality and was not associated with reductions in utilization of hospital, emergency department, or ambulatory care services or total costs over 3 years. These findings suggest that medical home interventions may need further refinement.

Was there any reader of this blog who was surprised by this?  I have been blasting this farce for YEARS!  What was funny was this study was sent to me by a bunch of you guys, even before I saw it.  Thank you.  Your initial thoughts included:

  • So If my reading skills are good, millions of dollars were spent on this study, and hundreds of millions nationally on ‘Medical Homes’, and the only measurable improvement was more microalbumin testing?  And we’re supposed to have all our diabetics on ACE/ARB anyways so that microalbumin is a test without an intervention?  Shouldn’t we just pay FP’s more, and let them create their own ‘Medical Homes’, also known as Practices?  I know, I’m preaching to the choir.
  • I’ve never been an AMA member, but they’ve been sending me JAMA for the last decade.  Absolutely devastating.

So, now that the government and hospitals and insurers bought into this crap hook, line and sinker, what kind of further refinement do you think is going to happen?   My guess is that they will focus on the money aspect and cut out the physicians some more because, obviously, they are costing too much.   Maybe an addition of a few more administrators should help, too.

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] 

  7 comments for “Patient Centered Medical Homelessness

  1. R Watkins
    March 10, 2014 at 3:12 pm

    The PCMH Industrial Complex rushes to the rescue of its sickly baby:

    http://www.pcpcc.org/2014/02/26/pcpcc-leadership-responds-jama-article-medical-home-pilot-study

    Would love it if someone could explain in simple English what she’s trying to say.

    • Doug Farrago
      March 10, 2014 at 6:37 pm

      I will have to blog about this crap soon. Thanks for tipping me off.

  2. tad hominem
    March 2, 2014 at 10:09 pm

    so u have become the nostradamus of Family Practice !! congrats. so how does this crap get proposed and funded ??

    • Doug Farrago
      March 3, 2014 at 1:34 pm

      I am called Nostradougus. The only way to fix this crap is to walk. Direct Primary Care if you are a family doc.

    • Kurt
      March 9, 2014 at 2:42 pm

      7.5 years to retirement and I hope I can last that long. When I’m done, I’m done. No volunteering at free clinics because it will cost me to maintain “certification”. I am going to be needing all my money to fund my own retirement let alone the lackey’s at the ABFM and AAFP who want my money for their CME requirements
      (and their retirement funds)
      Nothing will change in this country until people are held responsible for their “shitty” health habits PERIOD!
      A touchy feely “home” is not going to do it.
      Doug’s direct primary care and Atlas Medical is a fine idea but will not fly in all areas dependent on entitlements. If one doesn’t have the ability to get a specialty colleague to see a patient in need or get pricey tests or procedures, one could be on the hook trying to provide care for something out of their ability.
      I’m glad the Docs at A.M. have found a niche they can fit in and prosper.
      The only thing that will change things is if significant financial incentives are provided for those who achieve some semblence of good health. Yeah I hear it has been tried but it needs to be significant financial incentive for one to consider making the “change”. (ie. significant premium discounts)
      I consider it obscene that an insulin dependent diabetic who makes a significant effort and maintains excellent control of weight, lipids, BS and glycohb, still gets screwed royally as far as premiums are concerned. Enough ranting. FP is going to be going to the NP’s anyways once they don’t have to have a
      supervising physician. There are some pretty good ones out there too. I supervise one and she does a very good job. Really doesn’t need me. I’ve reviewed some of her referrals and I could only find a few I might of tried something else with but in the end, I think I would have sent them off anyways. Sometimes my threats of dialysis don’t sway as much as when a nephrologist theatens and shows my patient the inside of a dialysis unit. I’ve seen several diabetics start to pay attention after that “blind appeal to authority”.

  3. Dave F.
    February 28, 2014 at 9:50 am

    Doug, I also went to the website to e-mail this to you, and saw it already posted! This should also be cross posted in “Useless Study of the Week!”

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