Medicare to fund Medical Homes

How odd, I was just talking about this today. It's about time.

The "medical home" is quite a bit more complex than CMS paying MDs more to "coordinate care" as the WSJ describes in this brief article. The true medical home is about having comprehensive system-wide case management involving all the levels of care with an emphasis on chronic disease mgmt. A big and necessary part of includes an EHR system that allows (or better yet - demands) communication across the spectrum of care. The way the WSJ describes it it is just a form of capitation which has proved ineffective in the past. Why?, do the math. If I am doctor with 200 patients who qualify for this incentive, I get about $400 a month. But if just put 10 patients in the hospital for a week per month (whether they need it or not is my call not those pesky UR nurses ) that is about $3500.

Case management is desperately needed for elders with multiple comorbid conditions and impaired function. In many cases, elderly patients are discharged from the hospital way too early, with inadequate resources at home to meet their complex needs (oftentimes under the care of a frail spouse). They then end up in the ER for one or two visits, then back in the hospital again (within a few days of the original hospital discharge). (Just had a case like this in the ER last night.) The costs to Medicare for this sort of mismanagement are enormous.

vicky, i totally agree with what you say about case management but one thing I have never seen is a patient discharged too soon from a hospital here in NJ.