I enjoyed the patient medical home article in the January/February issue (BCMJ 2017;59:15-17) but would offer possible corrections to the origins of the patient medical home. Paragraph 3 states that the “overall concept” of the patient medical home comes from the College of Family Physicians of Canada, referencing an article from 2016. Wikipedia (Medical home) says the first reference was by the American Academy of Pediatrics in 1967 advocating for special needs children. A primary care focus was formally endorsed by 12 national US family physician organizations in 2002 and published in The Annals of Family Medicine in 2004. Adoption really took off when Obama’s Affordable Care Act included a 10% Medicare premium incentive to certified physician medical home practices that met and documented clearly defined requirements. Currently about one-quarter of US family practices are certified by the National Committee for Quality Assurance and therefore entitled to a broadly based 10% premium. Results reported under this fairly direct approach were improved patient satisfaction and measurable care outcomes, a 2 to 1 return on investment, a Medicare reduction of $325 per person, and a 7% reduction in visits to the emergency department. The initiatives were physician led and broadly fee funded.
This payment model differs from more recent Canadian initiatives that focus on fee premiums attached to high-risk patients and support for integrating nonphysician public services and a shared EMR platform. Only time will tell whether our Canadian approach achieves similar or better results, because as Yogi Berra said, “It’s tough to make predictions, especially about the future.”
—Mike Figurski, MD, CPHIMS
1. Martin JC, Avant RF, Bowman MA, et al. The future of family medicine: A collaborative project of the family medicine community. Ann Fam Med 2004;2:S3-S32.
2. Weaver CA, Ball MJ, Kim GR, Kiel JM, editors. Healthcare information management systems: Cases, strategies, and solutions. Cham: Springer International Publishing; 2016.
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