Erik Gulbrandsen, D.O.

My clinic had an excellent conference today where we put rubber to the road in our attempt to become a fully recognized medical home. If you haven't heard of the concept, google it and read up on it. The medical home model is the premier model of medicine, one that focuses less on reactionary medicine and more upon preventative medicine (for "it is better to prepare and prevent than repair and repent"). This is what our patients deserve.

Now, to Earth. It is wonderful that I'm working in a clinic that places patient care and quality very high, maybe even higher than remuneration. I work in a state the provides no extra remuneration to clinics that meet criteria of the medical home. So, why would profit maximizing firms do it? It makes sense for a teaching program to do this, but private clinics have no incentive to spend the time and effort to get it done. Remember, we have to include opportunity cost when evaluating these changes. OC includes the amount of money lost working on implementation because the provider isn't seeing patients. For instance, I bet my program has spent tens of thousands of dollars trying to become a medical home, if not more. The medical home model will fail without a change of thought and remuneration. It is, at present, economically flawed.

Since we are currently attemtping to reform our healthcare system, we really need to focus on getting the medical home to succeed. We need to reimburse at a significantly higher rate those clinicians that provide high quality preventative medicine. Our current model of medicine is to remunerate for cause and effect, since it is easy to quantify. It is much more challenging to measure the value of prevention.

Confounding the whole issue is that preventative medicine has been shown to increase the costs of medicine, not decrease. Should we just give up on prevention? The answer is no. There is a difference between economic costs and accounting costs. Even though the accounting cost has been shown to be higher with prevention, I have yet to read a study that attempts to quantify the economic costs (and benefits). I bet that our economic benefits will outweigh the economic costs, though I can't prove it just yet.

In conclusion, I think the American people deserve a more organized and coordinated care, and this is it. However, status quo from the Medicare national bank will result in failure.