ACHIEVING A PATIENT-CENTERED MEDICAL HOME AS DETERMINED BY THE NCQA—AT WHAT COST, AND TO WHAT PURPOSE?

The authors, in a back-of-the-napkin calculation, figure that access to care, electronic prescribing, and encouraging patient self-management are more than twice as cost-effective as the components devoted to tracking data.

They are too modest. I would put the cost-benefit ratio as 100-to-1. Maybe 1000-to-1.

I have a well-run private practice. Patients are seen the same day if necessary or desired--always. Thorough executive-type physicals are scheduled next week, because it is a two-step process. In a recent audit of type 2 diabetics, my average A1c was 6.6; LDL-C was 91; BP was 123/75. Year after year, my cost-per-DRG runs 20% less than my family medicine peers.

The PCMH scoring system makes me want to weep. It is so larded with bureaucratic data collection, which in the average practice will never be acted upon or maybe even looked at, that I wonder if its inventors have ever practiced medicine.

And evidence-based? Where is the evidence for all this certitude?

You'll never see me wasting my time in pursuit of Medical Home certification, unless the process reorients toward measurable, research- based outcomes, rather that a checklist of inputs.

Confusion of means and ends is the root of the problem.

Competing interests:   None declared