Report from CEO Terry McGeeney

What's in a name

The difference between the right word and the almost right word is like the difference between lightning and the lightning bug.
— Mark Twain.

In the case of Patient-Centered Medical Home, the name adhering to the definition is of critical importance to the redesign of primary care.  Many practices or centers of care claim to be Patient-Centered Medical Homes.   Many physicians claim that they are already part of medical homes.  Also several pilots around the country are claiming to be medical home pilots when indeed they are chronic disease or pay for performance projects.

Primary Care in this country is at an interesting crossroads.  Surveys done both last year and this year reveal that only 50% of Family Physicians understand the Patient-Centered Medical Home.  With that in the background, many Family Physicians still feel their practices are Patient-Centered Medical Homes.   Over 90% of respondents in a recent survey felt they adequately coordinated care.  We are all aware that most practicing physicians feel they provide quality care until they are presented with actual data that is often in line with national experience of their patients only getting the care they need 50% of the time or less.  This national experience that many patients do not get the care they require based on nationally recognized standards, that many patients cannot get the care they desire when they desire it (thus the success of retail clinics), that the US health care system does not value primary care and thus the pay disparities and most importantly medical students are not choosing primary care at alarming rates.  This is not the time for primary care practices to say they are already medical homes which implies that the PCMH concept will not improve the status and value of primary care and the US Healthcare system.  While many practices may have some components of medical homes and some practice environments are more conducive, particularly rural practices, most practices do not have all or even the majority of the PCMH components to really make a difference.  Even practices that have many of the individual components still may not organize them in a way to truly make a difference to the patients or their practice.

There are many pilots planned or starting around the country that claim to be medical home pilots to capitalize on the energy around the concept.  The purpose of the Patient-Centered Medical Home concept is to focus care on the patient and redesign primary care practices, for the reasons noted above as well as to insure financial viability.  Some of the pilots around the country are really just chronic disease management projects or renamed pay for performance projects without a commitment to require or support practices in becoming complete medical homes as out lined in the joint principles agreed to by all primary care associations or clearly defined in the Patient-Centered Medical Home model of care.  While these projects may save more money for payers, they will not guarantee the survival of primary care.  Patient-Centered Medical Home pilots should also involve or test new ways to compensate primary care physicians for the work they do and don't get paid for such as care coordination and management of patients outside of the office. The PCMH concept is designed to maximize chronic care, disease prevention and wellness promotion with the focus on the patient first and practice second.  The TransforMED National Demonstration Project revealed that all components of the PCMH are interdependent and interoperable.  For chronic disease management to succeed a practice must address access and communication issues.

Primary Care has a unique opportunity that may not present itself again.  The concept of the Patient-Centered Medical Home has gained significant traction at all levels from Federal to State to local communities as well as from the corporate to non-profit worlds.  The Future of Family Medicine report and the Joint Principles clearly outlined a model by which to redesign primary care.  It is truly about primary care redesign and a new way of delivering care and not just a new approach to chronic disease management or pay for performance.  It is about the patient, the system and practice.  It is about the survival and reinvention of primary care.