I'm Not a Doctor

A second opinion on the challenges and opportunities facing today's physicians.

Medical home studies offer a mixed picture

1 pm, Feb. 23

“Proof of concept” medical home studies using a before-and-after methodology have come under criticism recently by some researchers, but even some critics acknowledge there is still nontraditional value to be found in some of the reports they generated.

One of those critics is Dr. David Meyers, director of the Center for Primary Care, Prevention, and Clinical Partnerships at HHS' Agency for Healthcare Research and Quality.

He co-authored an AHRQ brief titled “Improving Evaluations of the Medical Home”. It noted how much of the existing medical home research lacks the basic scientific ingredients of either randomized controls or matched comparison groups.

A comprehensive review of medical home research he co-authored is set for publication in the Feb. 28 issue of the American Journal of Managed Care.

I recently talked with Meyers about two early studies—involving the Danville, Pa.-based Geisinger Health System and the Community Care of North Carolina Medicaid medical-home network—which helped launch the medical home movement. He mentioned there were two others that were also influential, including one with less-than-encouraging results.

Meyers cited the pilot program at the Seattle-based Group Health Cooperative started in 2007 as being important in moving the medical home concept forward. He added that he has a special place in his heart for a 36-practice national demonstration project run by TransforMED, the for-profit medical-home consulting subsidiary of the American Academy of Family Physicians.

The project yielded eight reports published in a supplement to the AAFP's Annals of Family Medicine journal. While noting how the demonstration was linked to a 12% increase in practice revenue, the reports also told how patient satisfaction didn't necessarily go up—even with the addition of extended office hours and quick access to laboratory results—and that transforming a practice into a medical home was an arduous task.

At the time, Dr. Terry McGeeney, TransforMED's president and CEO, said patients sensed and were put off by “the turmoil of change.” Also, when physicians instituted “open scheduling” that allowed for same-day appointments, instead of increasing patient satisfaction, it raised suspicions that a practice was in trouble.

Meyers thinks the AAFP deserves credit for letting the world see that transforming a practice into a medical home can be painful.

“They should be given some sort of Academy Award statue or Purple Heart,” Meyers says. “They published even when the results were not all that rosy.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks.

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