ORLANDO, Nov. 17 -- The concept of coordinating the full range of a patient's care by a "medical home" and paying primary care practitioners to do it has won endorsement by the American Medical Association.
The AMA's policy-making House of Delegates accepted the idea at its interim meeting here. Although the working mechanism of the medical home is still undefined, a primary care clinician -- the probable keeper of the home -- would be paid to counsel patients, refer them to specialists, keep track of who is doing what for whom, and how it's all panning out.
Coding and reimbursement details were still vague. But some delegates said the devil is in the details. The house also said it would "work with all specialties to reform third-party payment and work to create payment policies that 'more appropriately' reimburse all specialties."
FP Marcy Zwelling, M.D., of Long Beach, Calif., told the delegates that paying primary care physicians for these services could "reinvigorate the specialty," and perhaps entice medical school students into the field.
Steven Stack, M.D., of Lexington, Ky., an emergency physician and AMA trustee, said that the way primary care physicians are currently paid gives them the message that their work is not valued.
"Current compensation mechanisms for health insurance in federal plans almost necessitate that you run patients through at a higher pace, because it doesn't place any significant value at the physician spending time at the bedside," said Dr. Stack.
The concept of a medical home is not new, and it is one that many physicians might agree is a logical way to structure patient care.
"The concept of the medical home is, on first blush, very intuitively right," said Aaron Spitz, M.D., a Laguna Hills, Calif., urologist.
The house adopted the "Joint Principles of the Patient-Centered Medical Home" that have previously been defined by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association.
According to a report from the reference committee that debated the issue before the house voted, AMA members supported "the 'medical home' concept, but also [expressed] considerable anxiety about the details associated with promoting the medical home as a model for patient care and physician payment."
"Our concern is how it's going to be paid for," Dr. Spitzer said. And according to Dr. Zwelling, the entire payment system would have to be restructured.
If it is not done right, the medical home could turn into a "mini HMO," Dr. Zwelling said.
Health insurance would need to be portable under a medical home model to prevent requiring patients to find a new medical home every time they switch insurance providers.
Some specialists are concerned that the extra money to pay primary care physicians would come from their pockets if the physician payment fees were restructured. Specialists are concerned about being marginalized, said Dr. Zwelling.
In its report to the house, the reference committee that recommended adopting the definition said it is "sympathetic to the need for careful study and consideration of the use of a medical home as the basis for physician payment reform."
Dr. Zwelling said that Congress would need to endorse the idea.
Last week, Sen. Max Baucus (D-Mont.) endorsed the medical home model as part of his sweeping health reform plan he hopes to pursue in the next Congress. (See: Senate Finance Committee Chairman Unveils Healthcare Reform Plan).