Senate Majority Whip Says U.S. Should Adopt Medical Home as National Model

The United States should adopt the patient-centered medical home, or PCMH, as a centerpiece of its health care system to improve quality and reduce costs, according to Sen. Richard Durbin, D-Ill., who spoke here on May 20 as part of the AAFP's Family Medicine Congressional Conference.

"Having a team of primary care professionals watching over patients' full medical history -- keeping people healthier -- is good medicine and good business," said Durbin, eliciting applause from conference attendees. "In my home state of Illinois, we are already seeing progress with the medical home model -- let's make it a national model."

Durbin, the Senate's majority whip, said one of the overriding aims of health care reform is to improve quality and save costs -- simultaneous goals that require a focus on wellness, preventive care and effective care management, which are cornerstones of the PCMH.

"That's why I like the AAFP model, the patient-centered medical home," said Durbin, recipient of the AAFP's Award for National Leadership in Government Service.

Durbin told the audience of more than 220 family physicians and medical students "medical homes are lifesavers for so many people." He said he plans to reintroduce a bill with Sen. Richard Burr, R-N.C., to establish demonstration projects in eight states based on the medical home model.

"Our health care system focuses too much on treating sickness at the expense of preserving wellness," said Durbin, a member of the Senate Appropriations Committee. "We spend too much on expenses that are unneeded and sometimes even harmful, including hospitalizations that could have been avoided."

The United States will spend $2.5 trillion on health care this year alone. That amount accounts for 16 percent of the nation's income and is twice the amount per capita that any other country spends on health care. Patients with chronic medical problems -- many of them preventable conditions -- account for 75 percent of medical spending nationwide, said Durbin.

And without family physicians, "the system couldn't work and won't work," he added.

"You really hold the front line when it comes to health care," Durbin said. "There must be a greater role for family physicians and primary care doctors. That was recently highlighted in the newspapers. We know we need more of you."

However, Durbin added, the U.S. health care system has been known to steal physicians from some of the world's poorest countries to meet its need for primary care health professionals. That practice must stop, he said, triggering a cascade of applause from the audience.

"We have got to create a pool of homegrown American talent to fill our medical needs," said Durbin.

Members of Congress, meanwhile, want family physicians to give them ideas on how to repopulate the ranks of FPs, according to Durbin. Lawmakers also want to hear from family physicians on the topic of health care reform, he said.

"We now are in the process of trying to work this out, trying to put together some ways of fixing the system," Durbin said. "We have done some good things, but there is more to do."

He cited some recent successes of Congress, saying, for example, that Congress passed legislation banning genetic discrimination on the part of insurers and strengthened mental health and substance abuse parity by passing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

In addition, Congress recently expanded the Children's Health Insurance Program by bringing an additional 4 million children into the program. It also increased subsidies to help the unemployed retain their health care benefits.

With the recent enactment of the American Recovery and Reinvestment Act, the federal government also has provided money to help individual physicians purchase, install and upgrade their health information technology systems.

"I don't know if your practice is considering that, but it is a move in the right direction," said Durbin. "Integrated national health information technology is going to save lives, and it is going to save money."

Durbin also announced at the conference that he plans to reintroduce a bill to help small businesses buy health insurance. The bill, known as the Small Business Health Options Program Act, would allow small businesses to band together to buy insurance and spread the risk over a large number of participants, allowing them to obtain lower premiums. It is based largely on the federal employees health insurance plan, which consists of 278 private insurance companies competing for the business of 8 million federal employees and their families.

"Understand that with costs going up beyond our control and with the number of people who are vulnerable growing exponentially, we have got to do something," said Durbin. But, he added, providing coverage for people without reforming the system is "not good enough."