One of the evolving models which will supposedly improve quality while reducing cost is the patient centered medical home, in which a physician takes greater responsibility for overall coordination of a patient’s care and health. It has been assumed that these physicians would be primary care doctors, but as might be expected, some specialists and physician organizations have objected to any exclusion of their ability to serve as medical homes. The regulatory and other definitions have danced around this issue by referring to “principal physicians” as the medical home. A New England Journal of Medicine Perspective discusses the issues relating to specialists as the location for a patient’s medical home. (NEJM Perspective)
Based on an informal survey, the author reports that not many specialists currently believe they serve as their patient’s primary physician. Specialists in very small practices were more likely to say they were. Yet for many patients living with a chronic disease, the specialist may be their most consistent medical contact and probably has the greatest expertise and knowledge about those patients’ main health problem. Specialists may in many cases be able to diagnosis and treat these patients more quickly and efficiently than primary care doctors.
The Perspective opines that specialists should be allowed to be medical homes, but only if they meet all the other requirements of being the primary source of care and have the process and information system capability to effectively coordinate and manage the patient’s care and health. If patients are going to be forced into a medical home model for their coverage, it would also seem that they should have a choice in the physician who serves that role and some patients may prefer a specialist. From a policy perspective, if we believe we have too many specialists and not enough primary care doctors, it wouldn’t be the worse thing to encourage some specialists to broaden their practice to serve as medical homes. Most certainly have the capability to do that.