Doccupy, EHRs and the Affordable Care Act

EHR Interface Design = a giant MESS

EHR Interface Design = a giant MESS (Photo credit: juhansonin)

It’s rare for doctors to turn out en masse for a public protest. But that’s what happened at “Doccupy” in Contra Costa County California in 2012. A group of safety net physicians testified before county supervisors — in what they only half-jokingly called “Doccupy” — that the cumbersome move to electronic health records (EHRs) had taken an enormous toll on patient care. The doctors saw half their usual number of patients. As a result, they told supervisors, one in ten patients left the emergency room without being seen and wait times ballooned from one to four hours — with one person waiting 40 hours for a hospital bed.

This protest came on the heels of a letter from a group of county jail nurses asserting concerns about the same electronic records system. A subsequent NYT article pointed out additional productivity and patient safety issues raised about electronic medical records at other locations, even from health care establishments as impressive as the Mayo Clinic.

It might be tempting to think of these stories as an aberrant blip. But surveys show Doccupy may have just been the first sign of trouble with electronic health records nationwide:

A survey of doctors by AmericanEHR Partners (a group co-founded by a health care technology company who you would think might present the rosiest viewpoint) revealed the following:

  • The average length of time that survey respondents had been using their EHRs was more than three years at the time of completing the EHR satisfaction survey.
  • Satisfaction and usability ratings are dropping. This holds true regardless of practice size, specialty type and across multiple vendors.
  • In 2012, 39% of clinicians would not recommend their EHR to a colleague.
  • Disatisfaction with ease of use was reported among 37% of respondents in 2012, compared with 23% in 2010.
  • And 32% of respondents had not returned to normal productivity levels in 2012 compared to 20% in 2010.

For nearly a decade, medical technocrats have touted the promise of EHRs to revolutionize health care (the Office of the National Coordinator for Health Information Technology was created under President George W. Bush’s Administration). The Affordable Care Act has hastened their implementation. The idea is that they’ll reduce paperwork and administrative costs. But as more providers jump onboard, the negative impacts seem to be growing.

EHRs are supposed to streamline health care and reduce errors, right? Unfortunately, not necessarily. Kaiser Health News reported on a JAMA-published study that found “nearly 30 percent of doctors responding to a survey say they have failed to notice important test results because of the deluge of information available with electronic records.”

Imagine if we went back in time, when EHRs were initially proposed. What if sponsors said at the time that these systems would decrease productivity for one-third of doctors permanently, and make one third of doctors more error-prone? Well, it seems like the research may have been missing in all the miracle claims. “‘The technology is being pushed, with no good scientific basis,’ says Dr. Scot M. Silverstein, a health I.T. expert at Drexel University quoted by the New York Times. He reports on medical records problems on the blog Health Care Renewal. He says testing these systems on patients without their consent ‘raises ethical questions.’”

And then there’s the cost. The Contra Costa Epic EHR system cost $45 million dollars. Trade publication FierceHealthITnotes, “One Health Affairs study put the cost for an average five-physician practice at $162,000 for implementation, plus $85,500 in maintenance expenses during the first year alone. Meanwhile, clinical and nonclinical staff spent 134 hours per person, on average, to prepare for use of the record system in clinical encounters, according to the study. The cost for a physician practice sounds like a bargain when compared to a large, complex system. For Detroit’s Henry Ford Health System, the price tag was a whopping $356 million, an outlay it said was a major factor in a 15 percent decrease in net income in 2012.”

Consider the health care efficiency math: That $162,000, plus another $85,000 in indirect costs, could almost pay for an additional full-time primary care doctor. Plus, the 134 hours devoted to the EHR implementation represents four and a half weeks of full time work for five physicians — six months of clinic time lost — all in addition to the price tag of the system. The $45 million for Epic in Contra Costa County would pay an annual $200,000 salary for 225 primary care or pediatric doctors. The $356 million price tag in Detroit clocks in at 1,780 full-time primary care and pediatric doctors for a year – and there are only 1,003 total doctors of all specialties practicing in Detroit!

These are the kind of hits our safety net systems can’t afford.

So what does this mean for you and your community? Here are some questions journalists can ask:

1)  How long is the wait time for a primary care appointment in your area? You might want to call around and get some numbers.

2)  How much has access been decreased (by number of slots available) for an EHR rollout? For how long? What is the cost of that, in human terms? Has it returned to normal? Will it ever?

3)  Follow the money. How much money is being spent on the systems in your area? By whom? The taxpayers? Which hospitals or practices have tapped into federal funding for their systems?

4)  How were contracts for these systems decided?

5)  See if you can find a local provider who’s willing to show you just how their system works – is it as “burdensome” as these articles describe?  Are test results buried in a pile of “information overload”?

6)  Will there be an attempt to intimidate you if you write about it? Do patients have a right to know what their system is like, or even how much the system commands of their doctor’s time?

7)  Are there obvious or predictable holes in the EHR? Are deaths recorded? By whom? Do transgender people have a way to fit into the allowable checkboxes?

8)  What was the alternative? Would rolling these systems out more slowly, and with more oversight and review, lessened their negative impact? Would they be better tested and designed? Would there be fewer errors?

Next, I’ll look at how many doctors are deciding to leave health care altogether, rather than face the burden, cost and disruption of EHRs and the Affordable Care Act.

Medical Homes Part III: The True Cost

Implenting Patient Centered Medical Home

Implenting Patient Centered Medical Home (Photo credit: Army Medicine)

As the Patient Centered Medical Homes (PCMHs) train charges forward along with implementation of the Affordable Care Act, dollars are taken directly out of our health care system to certify providers in a method with no proven benefit (see Medical Homes Part II: The Depressing Data). And, while there is a marked shortage of primary care providers nationwide, funds that could be used toward providing the direct provision of, or access to, health care are instead devoted to accreditation, surveys and assessments.

As we saw in Medical Homes Part I: The Reality vs. The Hype, estimates show that 27,500 clinicians and 5,700 clinics have already been certified. The cost of certification, which involves purchasing survey tools, consultations and site visits, vary but are conservatively $550 per clinician and between $275-$2,200 per site. Nationwide, those costs for accreditation translate into $15.125 million to certify clinicians and $8.55 million for sites (using an estimated $1,500/site and not including the jump in participants from 7/13-1/14).

Companies providing the accreditation are reaping the benefits. The Foundation Center shows that the Accreditation Association for Ambulatory Health Care (one of several certifying organizations) had a jump in revenue in one year (2011-2012) from $14 million to $16.9 million, just in the category of “program service revenue.” The National Committee for Quality Assurance, a major player in this field, has IRS 990s that show an increase from $17.2 million to $26.6 million in just two years. Their program service revenue alone in 2012 was $42.2 million.

Health systems are among the major players in the PCMH bureaucracy, but it can be difficult to find accurate pricing on their accreditation costs. Deep discounts are given to multi-site applicants who use complex multi-site calculator tools to try to estimate total cost. For safety net systems, accreditation is generally paid for with taxpayer funds as part of the cost of business.

In addition to the initial certification costs, there’s the spending associated with certification maintenance. PCMHs in New York receive supplemental reimbursement for all Medicaid patients, but only if they meet certain criteria and are certified by the National Committee for Quality Assurance’s program. A glance over what’s required leads one to believe that at least one staff member must be dedicated to compliance with all the compiling and reporting of these PCMH requirements. That person represents a dollar amount lost to the actual delivery of care. The cost of a full-time compliance position is substantial, but it is an amount missing from almost every overview or evaluation of PCMH programs.

When those operating costs are included, the price of being a PCMH becomes shockingly expensive, and represents a huge drain on our already struggling primary care system. The Commonwealth Fund’s summary of the operating costs of federally funded PCMH shows that the more regulatory PCMH rules are met, in general, the higher the operating cost. “A 10-point higher overall PCMH score was associated with a $2.26, or 4.6 percent, higher operating cost per patient per month,” which translates to “$508,207 annually for the average clinic in the study.” That amount could pay for 5 direct care nurses, or two full time primary care doctors, every year.

Even more sobering was the cost per physician time — the two subscales of “ability to track patients” and “capacity to perform quality measurement and improvement” were associated with an additional $27,300 per FTE physician. And remember these were PCMHs funded by federal taxpayer dollars. If we extrapolate these numbers to the 27,500 clinicians currently certified nationwide, that would translate into close to a billion dollars ($912 million) diverted away from the provision of primary care and into an unproven bureaucracy. When it comes to PCMHs, there are large economies of scale that are not available to individual clinics, or solo practitioners, representing yet another force pushing consolidation in our health care market, resulting in the rapid loss of solo practitioners and small group practices. This loss disproportionately impacts rural areas that are already struggling to recruit and keep primary providers. At its most basic, a federally-promoted bureaucratic program like PCMH that is supposed to support and elevate primary care should not be the kind of program that is harder and more expensive for lone providers in tenuously-served geographic areas.

In fact, improving access and communication, both of which rely on more available staff time, were the only facets of PCMHs that the Commonwealth study found could result in lower operating costs. But these savings weren’t nearly enough to offset the total operating costs of certifying as PCMHs as a whole.

And that study’s total operating costs don’t even come close to what New York’s Medicaid program paid. Between 2010 and 2012, New York spent nearly $400 million from a pot of money devoted to the health care of New York’s poorest, and often most medically fragile and disabled patients – to implement this certification bureaucracy. New York’s supplemental payments for PCMHs cap out at a max of $7 per patient per month for Medicaid Managed Care, and $28 per year for fee-for-service Medicaid. What may seem like paltry dollar amounts per person, add up to many millions upon millions of taxpayer dollars for the state — over $83 million paid as supplements to PCMH primary care providers in 2012 alone.

Looked at another way, using the data from the Commonwealth study’s ratio, that $7 per patient per month translates into $102,741 per physician FTE – enough, roughly, to pay for an additional half-time clinician every single year. Not included in that calculation is the lump sum $250 million that was allocated to 63 hospitals and residency programs to “transform” their primary care residency training programs.

The process to become a PCMH is also so onerous that, even with this much money on the table, only 34% of New York Medicaid clinicians were willing to participate. Over just three years, the dollar amounts for this bureaucracy keep rising: while participation in the PCMH program leveled off after the first year (reaching the peak of 34% of the total possible participants with 2%-5% increases quarter to quarter), in contrast, incentive money spent each year increased by roughly double the rate. There is no discussion in the final report as to why this is happening.

There is also notably no discussion of what the cost of implementing the bureaucracy might be if 100% of providers participated. One can estimate, however. Based on the numbers provided, if the rate of incentive-money-spent miraculously held steady, and100% of providers decided to participate (13,120 total providers), and there were no increased enrollment of Medicaid patients through expanded ACA programs, the total cost of taxpayer money is still an impressive annual $244,499,000 surcharge to our safety net system.

It’s hard to say exactly what this vast amount of money is buying for patients. But you may ask, even if there’s no clear benefit now, isn’t funneling some more money into primary care going to help our system? Can’t this program, in some way, help the lone primary provider?

Any savings realized through PCMHs will likely go to big systems. In addition to the economies of scale that PCMH accreditation and maintenance processes afford large health systems (making the initial “buy-in” and on-going bureaucratic support relatively cheap), the increase in operating costs for their primary care element are believed to be offset by the overall savings to a large health system. As the Commonwealth study points out, “A 2010 study of an integrated delivery system using PCMHs found savings of $18 per patient per month from reduced hospitalization and emergency department use. Yet under most delivery models, such downstream savings would accrue to health care payers, not physician practices.”

Furthermore, as Clinician Resources states, the PCMH model “does not offer monetary incentives for providers to work collaboratively and to optimize health outcomes. Additionally, most primary care practices do not have financial arrangements that would enable them to share in savings resulting from decreased hospitalizations and ED visits.” The New York experience didn’t even find potential savings to health payers. New York Medicaid hospitalization rates, including for preventable hospitalizations, appear to have gone up for patients in PCMHs, compared to those not in PCMHs.

But what about the private sector? Is the problem finding cost savings with Medicaid PCMHs purely because of the complexity of providing primary care to safety net patients? Group Health Cooperative, an often-mentioned program for demonstrating the “potential” of PCMHs, states in its 2009 comparison studies of adults within their own system, that “at 12 months, there were no significant differences in overall costs.” Even in 2012, when analyzing PCMHs’ impact on their patients who are seniors, they state “at 1 and 2 years, the PCMH and control clinics did not differ significantly in overall costs.”

The data on the much-lauded PCMH approach, a cornerstone of ACA, shows that it is expensive, onerously bureaucratic, a drain on health care resources, especially for primary care providers, and a distraction from health care delivery. And, if cost savings ultimately materialize, they are likely to go to large health systems, and not to sustaining, much less expanding, primary care.

If journalists want to examine how PCMHs in their area being implemented, here are some key questions:

1) How many primary care clinics serve your community? What is your state’s Medicaid approach to PCMHs?

2) How many local clinics have been certified as PCMHs?

3) How much did it cost the clinics to get certified?

4) What role did consultants play in the process?

5) Who is the on-going compliance-reporting person at a clinic or system? How much is their salary?

6) What do providers think of the PCMH-certifying experience?

7) Who has refused to get certification, and why?

8) How much local, state, and federal tax dollars are devoted to PCMHs in your area?

9) How much money will be recouped? From where are these projected savings coming? Is there any data to support the idea that savings will accrue?

10) Are patients any happier?

11) Is there any data that health outcomes have improved?

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Medical Homes Part II: The Depressing Data

Community Based Medical Home

Community Based Medical Home (Photo credit: Army Medicine)

When looking to examine Patient Centered Medical Home data (click here for my overview of PCMHs), there’s no better place to start than the 26-month evaluation of the multi-site National Demonstration Project. Begun in 2006, with results published in 2010, this federally funded project included an array of repeated cross-sectional surveys and medical record audits at baseline, 9 months, and 26 months, using patients from 36 family practices that were randomized into two groups: those practices that received facilitation to become PCMHs and those self-directed in their PCMH adoption. After all this money and time, the study found “no significant differences between groups” and “no improvements in patient-rated outcomes.” In fact, the only change found was minor improvement in scores on surveys that providers did about their care. Or, as the conclusion notes, “After slightly more than 2 years, implementation of PCMH components, whether by facilitation or practice self-direction, was associated with small improvements in condition-specific quality of care but not patient experience.”

New York state’s Medicaid program, which includes over 5 million enrollees and over 13,000 primary care physicians, markedly expanded payment for PCMHs, beginning in 2010. The summary report from April 2013 is, in many ways, both typical and chilling. After a glowing introduction and overview, including a background section that emphasizes the potential of PCMHs (without discussing the evidence, or lack thereof), the document has some notable findings. Three years into the program, despite an impressive amount of incentive money, only 34% of primary care providers were willing to become PCMHs. The graph on page 9 shows the growth in participation flattening out after one year. By mid-2012, 38% of New York state’s 5 million Medicaid patients were part of the project through their doctor’s participation.

See Also: Capturing a historic moment: Obamacare in California

Between 2010 and 2012, New York spent an estimated $398,947,964 taxpayer dollars (which includes a $250 million lump sum payment to hospitals and training centers) – money designated for the care of New York’s poorest, and often most medically fragile and disabled patients – to implement this certification bureaucracy (I’ll address the costs of programs like this in Medical Homes Part III: The True Cost). But for all the money and effort spent on New York’s PCMH bureaucracy, starting on page 14 of the report are some very underwhelming results. Most striking is the difference between the generally glowing written summary in favor of PCMHs (e.g., “These analyses show that PCMH practices have higher rates of quality performance, as defined by national standardized measures, than non-PCMH practices for a majority of measures after controlling for differences in enrollee case mix.”), and the actual reported numbers. Minor differences are noted, with simple adult and pediatric BMI measurements being the rare and largest difference in the groups to favor PCMHs. In many cases, non-PCMH providers performed equally as well as PCMH ones in preventive services, and outperformed them with a large difference in non-PCMH providers’ “avoidance of antibiotics therapy in adults with acute bronchitis.”

Conspicuously, data show that patients in PCMHs had higher rates of ED visits as well as higher rates of both overall andpreventable admissions to the hospital. Here’s how the shocking results are described in the discussion: “The utilization results, however, while preliminary, do not at this time show changes in the expected, or desired reductions in ER visits or inpatient stays.” It’s unclear why utilization results are deemed preliminary, but the outcome data are not. Nor is it clear why “at this time” is a pertinent modifier for only these poor results. Patient satisfaction results, a core component of evaluating patient-centeredness, is also notably missing, explained away by “as surveys are based on a sample of enrollees, 65% of whom do not respond, there is often not enough data to draw meaningful conclusions.”

In terms of other large PCMH projects, the Safety Net Medical Home Initiative was one of the largest nationwide PCMH implementation programs. Evaluation of it showed that staff resistance and turnover were obstacles. A more in-depth look at 5 safety net clinics in New Orleans showed more pressing problems than PCMH status, including “a need to focus on clinic finances.”

One notable study shows a marked benefit from PCMH implementation in a military center, with 7% improvement in access to care, a whopping 75% decrease in ED utilization and increased staff satisfaction scores after two years. Despite this, a larger VA study found more challenges and variability in just getting programs implemented, particularly around issues of open access to care. These conflicting results at clinics that operate within a military culture point to the difficulty in creating a standardized successful PCMH implementation.

An overview of published PCMH studies generally finds the data tending toward positive results, but plagued by “methodological and measurement issues,” a sentiment echoed by another review of the evidence. Drilling down, a large study of 58,391 patients seen at one of 22 medical groups between 2005-2009 found that any cost savings were limited to only the most medically complex, with some net increases in utilization and costs among other groups. A study of 27 Minnesota-based medical groups found little to no overall correlation between PCMH and diabetes care costs. Two Group Health Cooperative reports, from a study that is frequently touted as demonstrating “the potential” of PCMHs, when viewed critically, actually showed spotty improvements in some patient experience scores, no significant differences in outcomes, and no difference in overall costs with PCMHs, even for seniors.

Michigan researchers reported on the complexity and difficulty of just creating tools to measure PCMH assumptions — “13 functional domains with 128 capabilities within those domains.” Despite the fact that the whole goal of PCMH is standardization, they dispiritedly conclude: “a one-size-fits-all approach may not be appropriate.” PCMH standardization, tools and accreditation also do not, apparently, obliterate racial/ethnic differences in care.  A study of 1,457 adults receiving care from 89 medical providers within a PCMH-designated practice documented “racial differences in [both] processes and intermediate outcomes of diabetes care…” Another group concludes that after 15 years of NIH-funded projects “primary care transformation is hard work.”

In the face of such underwhelming results, after all the money and effort invested in a bureaucracy that does not contribute to actual patient care, several proponents (including the authors of the New York State summary) suggest that PCMHs just need a little more time to get established. Geisinger Health System touts its proprietary “advanced model” of PCMH. But even they state that, when it comes to better patient outcomes “there is only limited evidence regarding the ability of PCMHs to achieve this goal.” In terms of cost, their analysis of their own product shows “a longer period of exposure was significantly associated with lower total cost.” However, their calculated return on investment was grimly low, with a large confidence interval range.

Finally, and most importantly, where is the patient experience in all of this? If PCMHs do not clearly improve outcomes and cannot be consistently shown to decrease cost (and may actually increase preventable cost), do they at least make things more patient centered? Unfortunately, the answer appears to be no. As the evaluators of the 2-year National Demonstratin Project put it, “highly motivated practices can implement many components of the PCMH in 2 years, but apparently at a cost of diminishing the patient’s experience of care.”

Stay tuned for Medical Homes: Part III, The True Cost, to find out just how much of our health care dollars have been spent on this burgeoning bureaucracy.

The Gurley Rule of Bureaucracy: The complexity of a bureaucracy is inversely proportionate to the clarity of the idea behind it.

Following on from the first post about Medical Homes and the bureaucracy that was involved in creating and driving the concept, here are some thoughts on medical bureacracy.

Good Bureaucracy: If you’re in health care and you amputate the wrong limb, that is bad.

1) While not as simple to avoid as initially believed, there are achievable preventative steps to help ensure better outcomes.

2) It is unambiguous when such a tragedy has happened.

Illustration for the topic of bureacracy. The ...

Illustration for the topic of bureacracy. The form is fictional. (Photo credit: Wikipedia)

3) If you do this to someone, you will be punished for it, and…

4) if you haven’t been doing those preventative steps when it happens, you’ll be punished even more. That is a level of bureaucracy I really support.

Bad Bureacracy: The flip side of health care bureaucracy proliferation includes:

1) The boom and bust years of Diagnosis Related Groups: the hubris of thinking that all diagnoses – such as all diabetics – should just be paid one lump sum for all their care, no matter how sick or complex the person’s illness.

2) All of ICD-9: the hubris of thinking that every disease in human experience can be numbered, even before you have a diagnosis, and used as the basis for payment of a doctor’s time.

3) The tsunami of ICD-10: Since ICD9 has become a disastrous bureaucratic nightmare, the Center for Medicare and Medicaid Services (CMS) decided to … massively expand it (150,000 codes!). ICD10 will not only require changing every single current health-technology tool right after they were implemented, but will also give us such gems as specific codes for “struck by a turtle” (W5922XA) and “burn due to water skis on fire, initial encounter” (V91.07XA, see more here).

Medical Homes Part 1: The Reality vs. The Hype

English: Barack Obama signing the Patient Prot...

English: Barack Obama signing the Patient Protection and Affordable Care Act at the White House (Photo credit: Wikipedia)

Patient-Centered Primary Care Medical Homes (PCMHs) are all the rage. A frequently-touted part of the Affordable Care Act (ACA), they have received literally hundreds of millions of dollars in federal incentive and demonstration-project funding. They’ve been around for decades. In fact, the more you know about the intention behind the creation of a primary care Patient-Centered Medical Home (PCMH), the more you want to ask, “Well, of course – how could that not be a good idea?”

But is it?

Creating a medical home means building and using an integrated approach to health care where each piece of care is not treated separately and does not take place in isolation – nor is it all billed separately. Health care, communication, co-ordination, complications, follow-up and payment are all part of one system led by primary care.

PCMH is often reported as having started in 1964 by pediatricians, in order to improve the kind of fragmented, episodic and uncoordinated care that special needs children received at the time. The idea was that the primary care doctor (a pediatrician) was the “home” for all health care, and that the patient’s family, and a care coordinator, were key members of a team.

While generally acknowledged to be an improvement for families then — numerous opinion and consensus/expert panel papers exist — it is surprisingly hard to find any randomized comparison data to support their efficacy. Despite this, PCMHs seem to inspire some of the most vaguely worded and glowing descriptions ever applied to a federally-funded regulatory initiative.  Check out this polished video from one of the Medical Home accreditation organizations. You’ll see retro-Marcus-Welby hype, followed by person after person struggling to explain exactly what a Medical Home is. Even the most technocratic PCMH document will often begin explaining a Medical Home as “not a place, but a model” of care. “It’s an ideal.” Or, “it’s a concept.”

If you step back a bit, however, this revealing set of phrases presents a large number of uncomfortable questions, especially when vast amounts of health care dollars are at stake. Such as, if you’re trying to change your primary care practice into a PCMH, how do you define a “concept of care”? Or, if you’re a funder, how exactly do you pay someone more or less money based on whether they’re following the “concept” or not?

Similarly, if “team-based care” is a huge part of the concept behind a PCMH, who will decide if a collection of people is actually a team or not? After all, an autocratic doctor (or any other uncooperative health care provider) plunked into a mandated “team” of other providers will likely remain just that — uncollaborative. And finally, when it comes to patients, does the same health care “concept” achieve the same outcomes for each unique person?

In an effort to define the undefinable, a complex number of criteria have been created. Just check out the multi-faceted array of “voluntary” PCMH certification criteria that currently exist, such as from the National Committee for Quality Assurance, the Accreditation Association for Ambulatory Health Care and The Commonwealth Fund. Which criteria is better? Easier to certify? Or more effective?

Even a cursory glance at our current definition shows that the Medical Home idea has become far broader and more complex than that original approach. More modern health care strategies, like managing chronic conditions through disease registries and using Health Information Exchanges (HIEs) and Electronic Health Records (EHRs), are now central to PCMHs. There are also clearly conflicting criteria, such as the twin goals that patients always have ready access to their assigned primary care provider (empanelment), and that patients receive their care through specified teams of non-physicians (coordination).

There’s also an assumption that PCMHs are right for every patient, even those with more minor medical problems. In general, the ability to just make your own appointment with a dermatologist or orthopedist goes away. You need to go through primary care first. Even for something as serious as a new cancer diagnosis, that care is supposed to be launched and monitored through primary care.

Additionally, a striking issue when looking over the criteria for PCMH certification is the fact that surprisingly few requirements make a clinic more “patient-centered.” Engaged leadership? Use of electronic health systems? That is what patients care about, more than anything else? If it is not proven that this criteria actually makes care more “patient center,” is the title of this initiative more about clever marketing? Afterall, who in health care wants to stand up and say they’re opposed to being “patient-centered”?

Despite these issues, PCMHs are proliferating rapidly. The Alliance for Health Reform’s 2013 book Covering Health Issues: A Sourcebook for Journalists, lists on page 53 the institutions and initiatives involved in documenting PCMH status – a dizzying number of agencies with their hand in the pot. With, as of May 2013, over 27,500 clinicians and 5,700 sites PCMH certified, certifying PCMH status is no longer a simple Do-It-Yourself process for clinics, but a booming nationwide industry.

But all this time and effort to make things “patient centered” has to be worth something, right?  Or is it just bad bureaucracy taking over another part of health care? Bad bureaucracy in health care isn’t just annoying. Estimates are that it eats up one third of our health care budget or as much money as it would take to care for all the uninsured. PCMHs stand to create more. As one example, between 2010 and 2012, New York’s state Medicaid program spent an estimated $398,947,964 taxpayer dollars (which includes a $250 million lump sum payment to hospitals and training centers) – from money designated for the health care of New York’s poorest, and often most medically fragile and disabled patients – to implement this certification bureaucracy.

In my next post, Medical Homes: Part II, The Depressing Data, I will round up and summarize for you what the investment of millions of dollars has actually produced. Afterwards, in Medical Homes: Part III, The True Cost, I’ll examine how the certification and implementation process takes time and resources away from patient care.

Investigating drug rehab, overdose death prevention in your community

Image of Cory Monteith by vagueonthehow via Flickr

Hollywood stars, like Glee’s Cory Monteith, aren’t the only Americans struggling with addiction that kills. Monteith, who died of a heroin and alcohol overdose earlier this month, exemplifies the public health tragedy that is opioid overdose deaths in America. The fact is, there is no […]