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Physician Practice Too Small for a PCMH? Think Again

Philip Betbeze, for HealthLeaders Media, January 21, 2011

Making your physician practice into a patient-centered medical home can seem like a daunting proposition. There's investment involved, sure, in technology and in staffing. Depending on a lot of factors, it could be a big investment for a business that likely doesn't generate a whole lot of margin. And I'll concede that the return on that possible investment is murky at best. But if you're not trying to develop a medical home out of your primary care practice, don't let being "too small" be your excuse.

Why? Practices don't get much smaller than that of Joseph Mambu, MD. And he's doing it.

Mambu is one of only two full-time physicians at Family Medicine, Geriatrics and Wellness in Lower Gwynedd, PA, although he also employs another part time. He also has three part-time nurse practitioners. He's an early adopter of the medical home concept, however, and he is certain there will still be a place for the small physician office under healthcare reform, provided they make some very big changes, as he has, over the past five years.

The medical home, also known as the patient-centered medical home, briefly, is a largely theoretical concept that envisions a location where patients can obtain their primary, preventive, and acute medical services at the same location and through the same physician. When they need inpatient or specialty care, the primary care physician's care team coordinates it and works to stamp out unnecessary duplication of tests and services.

In its most evolved state, the medical home physician uses decision-support tools created through evidence-based medicine protocols, quantitative indicators of quality, health information technology, and feedback on physician performance. The problem: reimbursement doesn't necessarily encourage their growth—at least not yet.

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