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February 26, 2014 at 07:48 AM
(Bloomberg) — Medical homes, a much-touted model of patient-centered primary care that emphasizes better coordination, don’t reduce visits to hospital emergency rooms and provide limited health benefits, a study found.
Medical homes in the Southeastern Pennsylvania Chronic Care Initiative also didn’t save on costs compared with normal primary care practices. Instead, the homes accumulated bonuses of $92,000 per physician during a three-year pilot program, according to the study released today in the Journal of the American Medical Association.
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Medical homes have gained popularity as health-care costs rise in the U.S. and the population ages. A physician-led team focuses on comprehensive and continuous care such as calling patients to remind them to take their medication and schedule follow-up visits. Medical homes also coordinate care among specialists, hospitals, and nursing homes.
“The findings were surprising,” Mark Friedberg, the lead study author and a scientist at the Rand Corp., a nonprofit research institute based in Santa Monica, California, said in a phone interview. “Expectations for the medical-home model were quite high and this was not consistent with previous findings.”
Today’s study involved 32 medical homes in the Pennsylvania program, one of the largest pilot projects in the U.S. with $20 million in funding during the first three years. It compared the medical homes with other provider practices from 2008-2011 and found significant improvement in one of 11 quality metrics.
Previous research of medical homes showed “modest improvements,” Friedberg wrote in today’s study, but were far smaller and shorter in duration.
PPACA encouragement
The principles behind medical homes have been embraced by President Barack Obama’s administration. The Patient Protection and Affordable Care Act set up “accountable care organizations” in the Medicare program, networks of doctors and hospitals that are rewarded if they coordinate care efficiently to keep their patients well.
“There are a lot of enthusiasts that are going to be offended,” said Thomas Schwenk, dean of the University of Nevada School of Medicine in Reno, in a telephone interview. “I do think this is an important model, but it has been spread widely and indiscriminately. It’s a powerful and expensive model that needs to be better understood.”
Critics of the study say it is outdated, as the medical home model is rapidly evolving.
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“This has been a work in progress,” said Margaret O’Kane, president of the National Committee for Quality Assurance in Washington, D.C., which sets standards for medical homes and had recognized the ones in the Pennsylvania pilot program. “We updated our standards in 2011, and again in 2014.”
