Is the medical home concept impractical for solo physicians?
Nice concepts finish last
The patient-centered medical home has become the Holy Grail among the leadership of primary care organizations like the American College of Physicians ["No place like home," July 24, 2009]. So much effort and time have been wasted over the past three years while the economic health of our practices has been placed on life support. The medical home is a nice concept, but totally impractical for a solo internist.
MARC SOKOLOW, MD, FACP
Bonus or bust
Yes, electronic means of contacting patients and following them is an advantage, and soon we will have Big Brother monitoring each one to be sure he eats and exercises right.
MURRAY GROSSAN, MD
Los Angeles, California
Back home again?
As a neurologist in the suburbs of Indianapolis, I can tell you there are no primary care doctors that aren't owned by a hospital ["America's best places to practice," July 10, 2009]. I recently tried to help one disenchanted primary care physician transition away from a hospital-owned practice, only to see him return to an institutional setting. He couldn't make ends meet due to the very low reimbursement from private and public sources.
A recent newspaper article stated that Anthem WellPoint has an 80 percent market share and continues to reduce payments to both hospitals and physicians. A medical society survey suggested over 70 percent of primary care physicians do not plan on practicing medicine in Indiana by the end of this year. The specialists are now also looking for greener pastures, and groups are arguing over their incomes, causing some to split. So how is Indiana a desired location to practice?
JAMES COOK, MD
Response from David Cornett, vice president of business development for Inpatient Management Inc.: As healthcare becomes more regulated and pressures on reimbursement escalate, more physicians will look for "greener pastures," and groups will continue to struggle over compensation plans. These are not just Indiana problems; they exist in every state.
Given these circumstances, Indiana is still a good place to practice for many reasons. Compared to many other states, it has good healthcare facilities, good access to those facilities, a relatively stable malpractice climate, and a low cost of living, among other considerations.