RE: FW: The National Medical Home Summit

[Guest guest]

I wonder how many of the presenters are IMP or even a small (3 practitioners or less) medical practice?-- Pedro Ballester, M.D.Warren, OH

[Guest guest]

This looks like a great list of speakers,

any number of whom are likely to point out the flaws in the current methodology

being promoted to measure “medical home-ness.”

The current tool (NCQA’s PPC PCMH)

has some good elements but relies too heavily on infrastructure and process and

not enough on important outcomes. As I’ve pointed out before, it

emphasizes a large team approach to care – thus confusing form (“diabetes

nurse educator”) for function (“diabetes education”).

The latter is what makes the difference for patients. One path to the

good education is indeed a good diabetes nurse educator, but to posit that this

work cannot be done by a good provider means that this approach is likely to

write off the 45% of practices in the US that are solo and small.

The second big flaw is that this tool

obscures the importance of the fundamental attributes of effective primary care

(first point of contact, relationship over time, etc). In doing so it

over-emphasizes vendor driven solutions (like ePrescribing) and weak

interventions (“we have a policy that says we’re really good with

access”). Organizations and normal docs are likely to be caught up

in the overwhelming detail of the 109 different measures and fail to address

the fundamental work. This has been pointed out by Bob Berenson (one of

the key speakers) as well as Dana Safran (big Tufts researcher), and Barbara

Starfield (decades of research on primary care).

If the conference fails to address the fundamental

flaws in the PPC-PCMH tool it will be an expensive waste of time. If key

speakers raise this issue (as they have done repeatedly in private but to no

seeming effect with NCQA) then maybe there will be a good conversation on how

we might use the NCQA tool for its strengths but mitigate its weaknesses with

other tools and approaches, thus opening the door to the 45% of practices that

are solo & small.

Gordon

From: [mailto: ] On Behalf Of Pedro Ballester

Sent: Saturday, December 20, 2008

11:18 AM

To:

Subject: Re:

FW: The National Medical Home Summit

I wonder

how many of the presenters are IMP or even a small (3 practitioners or less)

medical practice?

--

Pedro Ballester, M.D.

Warren, OH