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Marcus Welby, with Computers

Philip Betbeze, for HealthLeaders Media, November 5, 2010

If you read the tea leaves, they aren't falling in favor of small primary care physician practices. Squeezed by high overhead and falling reimbursements for years, many of these physicians have simply given up—retired—or moved on by selling their practices to larger institutions like large group practices or the local hospital. That's not a bad model, necessarily. There are lots of physicians who are relieved at the ability to leave behind the small business headaches associated with small practices of one to a few doctors.

But others want to improve as much as those in the big practices and hospital-based situations, yet remain independent, and they're finding that creating the elusive medical home for patients—a move that is as much about practice health, given the reimbursement climate, as the patient's health—does pay off, to a degree. Count Joseph Mambu, MD, 62, of Lower Gwynedd, PA among that group. I caught up with him recently as he was driving to a house call. Yes, you read that right. Mambu makes house calls, frequently because he's the only thing between his patients being homebound and hospital-bound.

He's the only full-time physician at Family Medicine, Geriatrics and Wellness, and although he has two part-time physicians to help him with his patient load, the key is computerized patient information, and the team of caregivers with whom he's surrounded himself. Critical to Mambu's practice, and to lowering healthcare costs nationwide, is the chronic care population. Mambu, who is also a geriatrician, says he's never been satisfied with the way healthcare deals with this highly expensive patient population, but he's never found a good way to coordinate that care until relatively recently.

He's been a family practice physician since 1976, and was in a group practice model for 22 years. Back in 1998, he sold that practice to a local hospital, thinking being part of a large health system would be a model to get coordinated care for his patients. In short, it wasn't, at least at that time.

He says the local hospital, which he wouldn't name, did a terrible job of human resources and micromanaged the practice to the point that he decided to leave after 2 1/2 years. He sees that bad experience as a blessing now.

"Had they not mistreated me, I wouldn't have had the gumption to start my own practice and would have never gotten involved with this [patient-centered medical home] movement," he says. "I always wanted to do this; it just took me 25 years."

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