4 Reasons PCMH Principles Aren't Going Away

Philip Betbeze, for HealthLeaders Media , March 7, 2014

A recent analysis finds lackluster results in both cost reduction and quality improvement from organizations that have achieved Patient-Centered Medical Home certification. Does that mean we need to go back to square one?

Have you heard the news? The patient-centered medical home model is a failure.

One takeaway from a recent analysis on the medical home is that for all its purported promise, the designation appears to be little more than window dressing for practices that achieve it.

The report, published in last week's JAMA, and covered well here by my colleague Cheryl Clark, compared quality, utilization, and costs of care delivered to about 120,000 patients in 32 Pennsylvania practices. About half of the patients were treated by physicians in PCMHs certified or recognized by the National Committee for Quality Assurance; the others were treated by physicians in traditional practices.

The conclusion? Physician practices designated as medical homes were no better at controlling costs than traditional practices and were better in only one of 11 quality measures evaluated.

But it would be wrong to dismiss the movement toward patient-centered care as ineffective based solely on the findings of the study.

The report found that compared with traditional practices, NCQA-certified PCMHs did no better at controlling costs than traditional practices. They also did not improve on traditional practices' performance on 10 of 11 quality measures evaluated, such as cholesterol testing and cervical cancer screening, or in avoiding emergency room visits of patients who could have been seen in an ambulatory setting. The only measure where some improvement was seen in the medical home groups was in nephropathy screening for kidney disease in patients with diabetes.

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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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