Proposed Medical Home Pilot Program Raises Questions

Making the rounds on coffee row these days is the consternation over a concept called medical homes that are supposed to cut costs for Medicare and HMOs.

Medical homes seem to be a radical idea that no one wants to discuss and the Center for Medicine in the Public Interest (Center for Medicine) has some concerns about the concept. While they agree that there needs to be cost cutting measures to get a grip on Medicare expenses, they aren’t too enthralled with the idea of medical homes.

These “homes” are way, way back in the health care reform bill in the inevitable fine print. What the text proposes is the establishment of a medical home pilot program for disabled persons and for seniors. It seems the idea would mean providing a medical home for every person during the long process of America moving to a wellness based system, instead of remaining with the current sickness based model.

This idea begs the question of what would happen to Medicare, Medicare supplements and a whole host of other scary questions that people can’t really wrap their minds around. On the surface the idea sounds like a great one, with the homes being operated by nurse practitioners and doctors’ assistants who would use evidence based medicine.

These individuals would hand out treatment to those in the home, but without the supervision of a doctor. There is also a question of what precisely does the term “treatment” mean – handing out medications or performing other medical procedures? How would these costs be absorbed and by whom? What the Center for Medicine is wary of is the imposition of “one-size fits-all” medicine handed out by only partially trained medical staff to cut corners and save the government and private insurance carriers some money.

Here’s where Medicare comes into the picture. The proposed pilot program would be aimed at Medicare patients with a high medical risk score, and/or those needing constant treatment or supervision. This type of patient requires the care of a physician, not just a nurse. And herein lies the concern of many seniors on Medicare and the Center for Medicine. This will put the proposal into perspective sharply. Right now there are roughly 22 million individuals eligible for the proposed medical home program.

The logistics of a program of this nature are staggering and one wonders if the government has any clear concept of what that would mean in terms of trying to set it up. To contemplate caring for 22 million people with just nurses and doctors’ assistants is a sobering thought. More to the point, how will this really save Medicare and the health system any money?

Think about that for a minute and the realization will dawn that someone will need to pay for this kind of care and if it’s not the government and insurance carriers, then it would be private individuals. Seniors on

Medicare and Medicare supplements barely have the kind of money to afford what they have now, how would they afford a medical care home?

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