Article from the New England Journal of Medicine: ‘Specialist Physician Practices as Patient-Centered Medical Homes’

In an article published on April 21, 2010 by authors, Lawrence P. Casalino, M.D., Ph.D., Diane R. Rittenhouse, M.D., M.P.H., Robin R. Gillies, Ph.D., and Stephen M. Shortell, Ph.D., M.P.H., the NEJM examines the specialist physicians role in the PCMH. According to the article, ‘This model [PCMH] is a prominent component of the health care reform bill recently signed by President Barack Obama and is being tested in dozens of pilot projects around the country; it has been promoted by the Patient-Centered Primary Care Collaborative, a coalition of more than 500 large employers, consumer groups, health plans, labor unions, and physician and hospital organizations.

Some specialist physicians are raising concerns about the medical home’s implications for their practices. Proponents of the model advocate reforms that would increase payments to practices that qualify as medical homes; these payments might well come, directly or indirectly, from funds that would otherwise have been used to pay specialists. In addition, some specialists who see patients frequently for a chronic disease believe that their practice should be able to serve as the medical home for those patients. For example, in recent testimony before a Senate committee, a representative of the Alliance of Specialty Medicine criticized the planned medical home demonstration project of the Centers for Medicare and Medicaid Services (CMS) for excluding surgeons and argued that a urology practice may be the most appropriate PCMH for patients with prostate cancer or bladder-control problems. The AMA House of Delegates recently passed a resolution in support of permitting specialist practices to serve as medical homes. The ACP Council of Subspecialty Societies has produced a detailed statement arguing that specialist practices that provide long-term “principal care” for a chronic condition should be eligible to serve as medical homes.’