Opinion

Patient Centered Medical Homes And The Hidden ‘Fundamental Transformation’ Of Obamacare

Joe Herring Independent Policy Analyst
Font Size:

The proponents of the Patient Protection and Affordable Care Act (PPACA or Obamacare), tout eye-popping savings sure to come from forcing physicians and hospitals to adopt the “Patient Centered Medical Home” (PCMH) model which features a heavy emphasis on preventive care as the primary means of lowering costs. (Prevent the disease = saving money treating the disease). However, like most things in life it’s not that simple.

PCMH requires coordinated care as the foundation of its model — from the primary care doc to the specialists and everyone in between, which might bring down overall costs from eliminating some duplication and redundancies, but has zero effect on the cost of preventive care itself; in the same way that insulating your house has no effect on the cost of insulation.

The most widely studied coordinated care company, Quantum Health, has some interesting data on this. Preventive aspects of care — labs for screening, prescription drugs, and PCP visits for the entire involved populations go up by as much as and in some cases to more than the cost of treating the individual chronic diseases themselves.

The lesson learned then is that preventive care costs money too and because it is applied to a much larger number of patients overall it erodes the savings expected from installing the PCMH model in the first place. The physicians end up seeing more patients for less money while the patients have an army of do-gooders nosing into their personal lives searching for “disease metrics” and “risk factors” so they can swoop in and “educate” them on how to eat properly or to exercise more. The only people happy with the plan are those major insurers and hospital groups (and the IT vendors that service them) who get paid to make the whole ball of wax grow.

This is only one of many Obamacare tentacles designed to actually complicate healthcare delivery in the name of streamlining it. I know that sounds counterintuitive; it is important to understand this concept and the principles that animate it, however, in order to realize that health care reform was never about making healthcare better or more efficient. It is instead, all about preparing our healthcare system for a quicker transition to single-payer, government-run healthcare.

The unstated, yet preeminent aim, of Obamacare is to create an economic climate in the medical field that is utterly inhospitable to anything other than behemoth consolidated hospitals and insurance organizations. The little guy has no role in the future of American medicine and Obamacare’s stunning tens of thousands of pages of regulations make certain of this.

Most people consider this to be an unfortunate, but unforeseen, consequence of the PPACA. In reality, this consolidation is no accident; indeed the law was written to bring it about.

Imagine for a moment, the hurdles facing a federal bureaucracy in transition from a pay-for-service, privately insured small-market health care system to a single-payer, government-run system.

From one state to the next, or even from one hospital to the next, coding practices often differ. Billing methods vary from one insurance company to another. The merging of networks, the adoption of compatible billing systems, figuring out how to get medical records from clinic A to hospital B in a timely fashion; all these represent thorny issues that would take years to work out.

If the federal government tried to take on the task of single-payer transition themselves, the costs of consolidation alone would likely exceed the value of the entire enterprise; not to mention the political heat an administration would take for being responsible for the greatest disruption in medical care in our nation’s history.

So Obamacare forces the private sector to do this consolidation for them by crafting rules that can only be followed from within a conglomerated “industrial medicine” model. In other words, Obamacare makes the private sector take the heat, do the work of consolidation, and work out all the bugs.

These resulting regional groups will be divided into hospital clusters with a multitude of clinical gateways to the system. Billing will be uniform throughout, from first contact to end-of-life care. The requirements Obamacare places on physicians and hospitals in order to be paid by insurance companies (who are operating under their own federally mandated billing rubric) all lead to one destination: a single leviathan conglomerate made up of insurance companies, major hospital groups, and a small cadre of physicians supervising many battalions of clinicians who staff “nurse-in-a-box” style ambulatory care clinics.

When the consolidations are complete, rather than taking control of thousands of incompatible systems, the federal government will only need to co-opt a handful of massive regional medical conglomerates, already built and operating, in order to install single-payer socialized health care in America.

Does Obamacare spell this out? Of course not. It simply creates the benchmarks knowing these aims can only be achieved through wholesale consolidation. If you want to see the end result, in both form and operation, look at the recent recalibration of the National Health Service (NHS) in Great Britain. Our bright future is their present day miasma.

When insurance companies suggest “wellness” exams and “health metrics” for you and your family to meet, they increasingly come with a carrot to entice you to visit one of “their” approved clinics (in which the insurance company often has an ownership stake) to evaluate your needs and craft a plan for better health.

While maintaining a healthy lifestyle is a good idea, make no mistake, these evaluations are data mining on steroids. The carrot offered – a discount on premiums or some other benefit – soon becomes a stick when you or a member of your family fails to meet benchmarks established by the bean-counters in charge.

Unlike our present system, where physicians are paid for the treatments and care provided, the PCMH model requires the patient to show sufficient improvement under the doctor’s care. Otherwise the doctor gets paid at a greatly reduced rate or doesn’t get paid at all. How then do you suppose a doctor is going to react when he tells you to lose weight and discovers you haven’t lost a single pound at the next checkup?

What about the diabetic who can’t keep their blood sugar under control? Or the COPD patient who still has shortness of breath despite the doctor’s best efforts? In the PCMH world, they will find themselves looking for a new doctor after having been summarily dismissed by their present one because the insurance company won’t pay for “failure.”

In a competitive healthcare industry the market evolves to absorb these people. In the coming PCMH world these people will be medical pariahs, forced to go to the only doctors that will take them; that being doctors who can’t get anyone else. In the end, they will die prematurely, leaving the PCMH group looking better for having fewer sick people on their rolls, not because they were cured but because they are dead.

Welcome to industrialized collectivist medicine, where a grey, formless bureaucracy is considered the peak of excellence; not by accident, but by design.