Friday, August 31, 2007

Clarification on Smiling Jack's Snake-Oil Show

I found a Wikipedia entry on the medical home con...cept that I mischaracterized the other day as "psycho-babble bullshit." What I really meant is, it's marketing-twaddle bullshit, which is even worse than psycho-babble. Anyway here's what the Wikipedia entry says:
Central to the Medical Home approach is the premise that patient-centered care requires a fundamental shift in the relationship between patients and their primary care physicians. There must be a higher degree of personalized care coordination, access beyond the acute care episode, and identification of key medical and community resources to meet the patients’ needs.
O.K., that sounds reasonable but scroll on down and see how the con...cept gets twisted.
Some suggest that the blended fee-for-service and partial capitation in this system mimics the “gatekeeper” models historically employed by managed care organizations. There are important distinctions between care coordination in the medical home and the “gatekeeper” model. In the Medical home, the patient has open access to see whatever physician they choose. No referral or permission is required. (Sounds reasonable, doesn't it, ES) The personal physician of choice, who has comprehensive knowledge of the patient’s medical conditions, facilitates and provides information to subspecialists involved in the care of the patient.(Here's where it gets interesting) The gatekeeper model placed more financial risk on the physicians resulting in rewards for less care. The Medical Home puts emphasis on medical management rewarding quality patient-centered care.
Let me see, as I understand this the "medical home" concept shifts the emphasis for insurance payments away from medical "specialists" to primary care physicians. From the Wikipedia article,
Primary care physicians, on average, earn about $90,000 less than the average specialist.[10] ...[T]he current health care payment system values medical procedures more highly than health maintenance and disease prevention through patient collaboration. The Medical Home concept moves payment towards a greater emphasis on physicians and their mid-level associates collaborating with patients to ensure health.
In other words it's a "share the wealth" program for neighborhood family docs and their more highly remunerated specialist friends. At the same time by "sharing the wealth" the unstated purpose of the "medical home" con...cept is to limit and over time reduce the number of medical specialists. Limiting the growth of medical specialists is controversial within America's medical community but as the pie for cardiologists, plastic surgeons, etc., become smaller more medical students will opt for the "general practitioner" degree. This explains former Iowa governor and current Des Moines University president and CEO Terry Branstad's inclusion on Smiling Jack's little snake-oil show.

So long story short, "medical home" just means the insurance industry and the health care industry works in coordination to shift the fee scale emphasis away from specialists to family docs and their staff. Like I said it's a share the wealth scheme designed to get kids, who'd otherwise enter medical school with thoughts of becoming millioniares by being dick-doctors or pussy-physicians, to think about being a kindly, old neighborhood sawbones, albeit one with a $90,000 per annum boost in income.

But won't this mean we, the sick public, will pay significantly lower healthcare insurance premiums.


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