Specialist Physician Practices as Patient-Centered Medical Homes | Health Care Reform Center

by awrence 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.

During the past few years, widespread support has emerged for the patient-centered medical home (PCMH) model of health care delivery. The PCMH combines traditional concepts of primary care (a personal physician providing first-contact, continuous, and comprehensive care) with newer responsibilities to systematically improve the health of the medical home’s patient population (e.g., through the use of chronic disease registries, information technology, and new options for communication between patients and the practice). The framework for the model was created by the American College of Physicians (ACP), the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and the American Osteopathic Association (AOA)1 and has been endorsed by the American Medical Association (AMA) and several medical specialty associations, including the American College of Cardiology, the American College of Chest Physicians, and the American Academy of Neurology. This model 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.2 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.3 The AMA House of Delegates recently passed a resolution in support of permitting specialist practices to serve as medical homes.
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