Some "Medical Home" pilots discriminate against small practices and their patients

Effective primary care is the foundation of high performing health systems.

Depending on the definition of "small," between 33% and 56% of practices in America are small (up to four physicians) or solo.(1)

The idea that effective primary care can improve quality and reduce costs in health care is finally dawning on business and some policy folks as they jump on the "Medical Home" bandwagon.

Many of the States are starting pilot programs to try out the concepts of "medical home."

So far so good.

The problems start when we find out in the small print of some of these pilots that they discriminate against solo and small practices.

Practices must have a "...minimum patient panel of at least 1000 patients enrolled in health plans that are administered by the payers participating in the Pilot..."
    Eligibility criteria in Maine's PCMH pilot.

Discrimination is wrong.  Pilots should include the very significant number of solo and small practices.

Solo and small practices have demonstrated willingness and ability to delivery on the principles of the "medical home."  Why shut them out?

L. Gordon Moore MD
Seattle WA

(1)Kane CK.  Physician Marketplace Report AMA Center for Heath Research Policy 2001