Where should OB/Gyn fit in the medical home?

[emeddo]

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As health care reform continues to progress in Washington D.C., it is apparent that a large group of providers are pushing the [URL="http://www.pcpcc.net"]medical home model[/URL] as the back bone for a reformed health care model. My question to all of you is where you feel OB/Gyn should be placed if such a model is adopted? Would you want to be eligible to become a medical home (at the minimum for young women in their reproductive years) or prefer to be permanently labeled a specialist? I fear the latter would be the case if OB/Gyns do not let their voice be known that we are willing to provide the full scope primary care needs of our patients (which is already the case in a lot of practices).

The CMS (Center for Medicare & Medicaid Services) Demo model of the medical home has a highly increased rate of reimbursement for primary care providers, a reimbursement OB/Gyns would not have access to if they are left out of the medical home and labeled a specialist. This means that the primary care doctors will have a competitive edge over OB/Gyn in providing any primary care services since their reimbursement rate will be much higher and they will be paid for the resources they use in managing/coordinating their patients primary care.

I'm looking for any thoughts, feelings, or resources anyone may have regarding this issue. Myself I was thinking maybe a hybrid model of where an OB/Gyn office may qualify as a PCMH (patient centered medical home) for young women during their reproductive years that is maybe linked to a larger medical home where the woman could be referred to when she was in need of a greater scope of primary care, but I am fully open to any other ideas. For all I know the majority of the OB/Gyn community is willing to completely sever their ties to any primary care which is why I throw out this post.

Thanks for your help

 

[THP]

I am not sure what a medical home is but if I wanted to do primary care I would have gone into primary care. I am also not trained to do the full scope of primary care. The higher reimbursement would be nice. In all honesty, young women don't really need a primary care provider. I don't have a PCP and I'm almost 30, I've only been to the doctor for required physicals.

 

[emeddo]

I am not sure what a medical home is but if I wanted to do primary care I would have gone into primary care. I am also not trained to do the full scope of primary care. The higher reimbursement would be nice. In all honesty, young women don't really need a primary care provider. I don't have a PCP and I'm almost 30, I've only been to the doctor for required physicals.

It is understandable that you do not want to provide primary care, but one thing to consider is that a medical home model is at its base a model of coordination of care for your patients, something I think a lot of practices already do for their patients among OB/Gyn specialists, therefore may already be serving in a 'medical home' fashion. If a model of reimbursement were to be supported that increased funding for such coordination, I don't think OB/Gyn would want to be left out of that funding.

As far as what a medical home is, that is a legitimate question. You can link to a good brochure here as well as a very general wikipedia article here.

Thanks for your feedback.

 

[MOHS_01]

Perhaps you have access to a more thorough explanation on the reimbursement mechanisms involved in this medical home push, but from what I have seen there exists very little in the way of concrete numbers. There seems to be a few proposals on how this should be implemented, ranging from the expansion of yet another Medicare arm (Medicare Part C, which also includes Medicare Advantage) to the creation of a new series of CPT codes for care coordination and related services, possibly even a redistribution subsidy provided to "primary care providers", to a direct 80% kickback for the restriction of services.... I mean cost savings... with no mention of how this would be measured. If you can provide any links that would enlighten us, it would be greatly appreciated.

Speaking specifically to the topic at hand, this is yet another example of the difficulty in attempting to label care providers and the vilification of non-FP/IM/Peds. They are incapable of providing obstetrical care at the level of the OB/GYN, and, unlike the brief push in the 90's, precious few OB programs teach enough primary care to feel competent in providing those services.