ACP Calls for Medical Home for Patients, Medicare Reform

"Primary care, the backbone of the nation's health care system, is at grave risk of collapse due to a dysfunctional financing and delivery system," says the American College of Physicians in a Jan. 30 report. (PDF file: 17 pages / 104 KB. More about PDFs.)

The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation's Health Care urges policy-makers to act now to save primary care by taking such steps as testing a model of care called the "advanced medical home" and reforming the Medicare fee schedule.

The advanced medical home, says the report, is a medical practice that provides comprehensive, preventive and coordinated care centered on patients' needs and that uses health information technology and other innovations to ensure high-quality, accessible and efficient patient care.

"The concept of the medical home resonates throughout the specialties of family medicine, internal medicine and pediatrics," says AAFP President Larry Fields, M.D., of Ashland, Ky. "In general, the ACP documents are consistent with the Future of Family Medicine project and with what the AAP (American Academy of Pediatrics) is doing."

In addition, the Academy supports the need for two changes in Medicare funding that the ACP report calls for: increased funding for evaluation and management services and replacement of the sustainable growth rate in the fee schedule formula. "If more money is directed at the primary care physician, the patient will be better off," says Fields.

The ACP also released a policy monograph, The Advanced Medical Home: A Patient-Centered, Physician-Guided Model of Health Care, (PDF file: 21 pages / 121 KB. More about PDFs.) that credits the AAP with describing the medical home concept as early as 1967 and says that AAFP described the medical home in its Future of Family Medicine report.The ACP monograph notes that "for most patients, the personal physician would most appropriately be a primary care physician, but it could be a specialist or subspecialist for patients requiring ongoing care for certain conditions" such as severe asthma, complex diabetes or malignancies.

Fields disagrees with this part of the ACP's plan, however. The physician in a patient's medical home needs to be a primary care physician, not a subspecialist, says Fields. "Research indicates people trained to practice primary care give better-quality care at a lower cost to the system. The big problem with the ACP documents is that they leave the impression that the subspecialist internist could provide the medical home. This isn't true. The subspecialist would need to make more referrals -- the patient would end up with many medical homes. Subspecialists can't provide primary care in a cost-effective manner."