Patient-Centered Medical Home Would Ease Burden on Primary Care Practices, Say AAFP, ACP

A recently released survey (85-page PDF; About PDFs) by the Boston-based Physicians' Foundation paints a distressing picture. It describes widespread unhappiness with the current practice environment among primary care physicians. So much so that nearly half of those surveyed said they planned to cut back on their patient panels or leave practice entirely within the next three years -- a prospect that would exacerbate existing access problems for health care consumers.

But, say the presidents of the AAFP and the American College of Physicians, or ACP, implementation of the patient-centered medical home, or PCMH, could ease both physicians' and patients' frustrations and bring back the pleasures in generalist medicine.

"The PCMH is what we're building for tomorrow," AAFP President Ted Epperly, M.D., of Boise, Idaho, recently told AAFP News Now. "The care-management fee (called for under the PCMH model) will help physicians obtain better payment. It would help make sure they get paid for non-face-to-face service time. The PCMH also would provide patients with more access to us and our expanded team."

The foundation based its report, which was released Nov. 18, on survey responses from about 12,000 physicians -- the vast majority of them primary care physicians -- throughout the United States. Those responses illustrate physicians' growing dissatisfaction with the status quo and reflect their concerns about the future of the nation's health care workforce.

Epperly said the survey findings add credibility to what the Academy and other primary care specialty organizations have been portraying to the federal government, insurance companies and the public about the difficulties that abound in physicians' business and practice environments. The report's findings, he added, could buttress the Academy's advocacy efforts.

ACP President Jeffrey Harris, M.D., agreed that it's important to improve the working conditions of primary care physicians if the overall health system is to remain viable. He pointed to a recent ACP white paper, "How Is a Shortage of Primary Care Physicians Affecting the Quality and Cost of Medical Care?" which warned that if national policies don't change to make primary care more attractive, the supply of primary care physicians will fall even further behind increasing patient demand, resulting in poorer health outcomes, more premature and preventable deaths, and higher costs for care.

"There is compelling data that by increasing the primary care base in the United States, we can lower the cost of health care and improve the quality," Harris said.

The medical home, he added, offers a prime vehicle for providing that kind of enhanced care, especially to the nation's burgeoning population of older patients. "The PCMH would give well-trained internists and family physicians the time to spend with patients with chronic health care needs."

Four primary care physicians' groups -- the AAFP, the ACP, the American Academy of Pediatrics and the American Osteopathic Association -- developed the Joint Principles of the Patient-Centered Medical Home (3-page PDF; About PDFs) in 2007. The principles recently gained more leverage when they were adopted by the AMA House of Delegates at its interim meeting in Orlando, Fla.

Implementing those principles, Epperly and Harris agreed, would greatly improve physicians' practice environments.