Comments on: The Medical Home Hits the RUC http://e-CareManagement.com/the-medical-home-hits-the-ruc/ Chronic Disease Management • Technology • Strategy • Issues and Trends Wed, 10 Mar 2010 19:15:42 -0700 http://wordpress.org/?v=2.8.2 hourly 1 By: Al Lewis http://e-CareManagement.com/the-medical-home-hits-the-ruc/comment-page-1/#comment-10411 Al Lewis Sun, 29 Jun 2008 15:45:56 +0000 http://e-CareManagement.com/the-medical-home-hits-the-ruc/#comment-10411 I've been following this medical home debate and already found what appear to be some assumptions which invalidate the whole concept. Perhaps I have the story wrong so could someone address these: First, are we assuming that the number of cases is constant except for prevalence increase, and that PCPs, faced with the prospect of much-incrased reimursement, won't suddenly find many more chronically ill patients who need care coordination? Second, is everyone else assuming that the level of preventable admissions and specialist visits (adjusted for increase in drug costs) is high enough to cover the program's costs? The DMPC Outcomes Measurement database, easily the industry's most valid with none of that actuarial voodoo, says there really aren't that many admissons which are preventable without spending much larger amounts on drug costs. (Others have also noted that prevention can cost more than cure.) Third, is everyone assuming that there is some kind of ongoing or imminent explosion in chronic disease-related events? once again, the DMPC database quite definitively says that usual care has kept overall event rates steady even despite pervalence increases. Inquiring minds want to know I’ve been following this medical home debate and already found what appear to be some assumptions which invalidate the whole concept. Perhaps I have the story wrong so could someone address these:
First, are we assuming that the number of cases is constant except for prevalence increase, and that PCPs, faced with the prospect of much-incrased reimursement, won’t suddenly find many more chronically ill patients who need care coordination?

Second, is everyone else assuming that the level of preventable admissions and specialist visits (adjusted for increase in drug costs) is high enough to cover the program’s costs? The DMPC Outcomes Measurement database, easily the industry’s most valid with none of that actuarial voodoo, says there really aren’t that many admissons which are preventable without spending much larger amounts on drug costs. (Others have also noted that prevention can cost more than cure.)

Third, is everyone assuming that there is some kind of ongoing or imminent explosion in chronic disease-related events? once again, the DMPC database quite definitively says that usual care has kept overall event rates steady even despite pervalence increases.

Inquiring minds want to know

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