Wednesday, June 4, 2008

Medical Homes - An Idea Whose Time Has Come?

Everybody knows patients yearn for the compassionate primary care doctor, Marcus Welby re-incarnated, to know, guide, protect, and empathize with them.

Everybody knows the health system is fragmented, meaning patients don’t know where to turn for general informed advice.

Everybody knows family physicians, internists, and pediatricians are in short supply.

Everybody knows the AMA/Specialty Society RVS Update Committee, RUC for short, has been criticized for undervaluing codes of primary care doctors, whose incomes are ½ to 1/3 of their specialty colleagues.

That’s why associations of family physicians, internists, and pediatricians promote the idea of a medical home, where doctors are paid more to coordinate care, collaborate with specialists, and serve as a clearing house of medical information.

But as always, DIITD, “The Devil is in the Details.”

Well, the Devils (CMS and RUC) have collaborated to offer these Details for a three year demonstration project involving 2000 physicians.

Here are the Details of the CMS-RUC proposal

Monthly Payment Tier 1 Tier 2 Tier 3

Physician $2, 364 $2,837 $3,346

Case Manager $5,145 $6,965 $8,841

Liability Insurance $190 $190 $190

EMR $0 $50 $97

Patient Education $97 $97 $97

Month Total $7,796 $10, 139 $13, 489

Year Total $93,555 $121,671 $161,871

I have no idea of the preparation or paperwork tasks or money involved to qualify for participation in the Medical Homes project,But I’m sure they are not insignificant.

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