A recent article in JAMA showed the disappointing results of a 3-year study of over 100 certified patient-centered medical homes in southeast Pennsylvania. Basically, it showed only 1 of 11 quality measures improved and utilization and costs were not reduced.
In one of the most narrow-minded statements by the AAFP ever, its current president stated that the PCMH is alive and well despite one negative study (italics added). The academy’s own study of the PCMH showed almost the exact same results of little improvement on quality, no cost savings, and no improvement in the patient care experience. A meta-analysis of PCMH studies published in the Annals of Internal Medicine in 2013 also found few changes in outcomes, except a small increase in quality measures, slightly fewer ER visits, but no decrease in costs.
To be fair, an organization called the Patient-Centered Primary Care Collaborative (PCPCC) has published more favorable outcomes on PCMH demonstration projects.
Following the Annals article, there was a commentary on the Healthcare Blog that talked about the exaggerations in past claims by the PCMH pushers, particularly those from the PCPCC. There are lots of comments after the original post if you’d like to read more of the debate, which I won’t repeat here. I got in there a couple of times. Suffice it to say that the PCMH is a flawed model that does not understand basic medical economic cost-effective realities (assumes prevention saves money, which readers of American HealthScare know is almost always not true), and it does not understand how family physicians deliver better care at a lower cost.
I’m most afraid that the PCMH movement will once again lead family medicine into a trap. In the 1990s, we let others define us as gatekeepers, a term I didn’t like the first time I heard it. It implied we were keeping people from the best care. Now we’re letting others define us not as family physicians who provide comprehensive care for complex patients, but as PCMHs. I believe there are some positive parts of the PCMH vision, especially the original AAFP/AAP/ACP statement, not the NCQA bloated definition (casual readers: you don’t want to know).
I deliver better care at a lower cost, not because I’m the titular head of a PCMH, but because I am a family physician. I just wish my national professional academy had the spine to shout this reality to the country.