Monday, October 20, 2008

Additional Follow-up on the Patient Centered Primary Care Collaborative: Will Physician Support Be Universal?

The Disease Management Care Blog has had another chance to review its notes from last Friday's PCPCC meeting. It recalls much of the data presented at the meeting lacked control groups and tests for statistical significance. Maybe the DMCB shouldn't necessarily expect the rigor of a scientific health services research meeting, but it is also reminded of the adage that initiatives like the Patient Centered Medical Home (PCMH) aren't cost saving until the Congressional Budget Office (CBO) says it's cost saving. CBO is going to need better data.

The non-critical fervor in the room over the Patient Centered Medical Home reminded the DMCB of the early pre 'hard science' days of disease management (DM). The underlying elements making up both approaches to chronic care – such as enabling autonomous patient self management, increasing reliance on computerized information systems, strengthening primary care and leveraging the expertise of non-physicians – was just as sexy back then as it is today. Who would have anticipated anything would get in the way of DM?

Unfortunately, what got in the way were a) a disconnect from physicians, that not only undercut its clinical effectiveness but hampered its adoption outside of commercial insurance settings, and b) the appearance of results from more rigorously conducted studies that undercut confidence that DM could reduce costs all the time for all populations.

Pending an answer to the data question, the DMCB asks if we can assume that all primary care physicians will rush to embrace the PCMH? Don't be be too sure. A literature search by the DMCB failed to uncover a survey of rank and file community based physicians concerning their opinions the concept. Lacking good survey data, a very savvy colleague pointed out that modern primary care physicians are increasingly seeking out positions with predictable hours and salaries. In contrast, the PCMH is predicated largely on an old fashioned ongoing “on call” style of practice. He wondered aloud if many of the time-clock punching docs envisioned as staffing today’s “Homes” would be more interested in getting home by 5:30 than staying late to keep a patent out of the emergency room.

Will efforts to implement the PCMH in its current form turn out to be a reprisal of disease management? Time will tell.

No comments: