Improving Health Care: Maybe Old Ideas Will Be the New Trick

In the mid to late 19070s I took post graduate study to become a nurse practitioner. I was also actively involved in health care planning at the state and federal levels. The idea to have a primary care "home"was a very popular idea at the time and was related to the move to create more nurse practitioners.

Another idea popular at the time was prospective reimbursement.

This article gives me a few chills when I read they think this is a new idea that is being studied. This was already studied, so why spend more money?

I know there was a lot of fraud with prospective reimbursement mainly because Medicare and Medicaid were closely aligned to this system. I worked on a case of fraud in billing by a rural coastal hospital for Washington state. I happened to have knowledge to help the state recover the overpayments. The county administrator just went off in the sunset.

It was good from the primary care aspect though because at that time we worked in solo practices, and independently. It was very different from the way NPs work now.

This better and more cost effective care allowed for continuity, much more education and prevention.

Medical "home" plan cut hospital admissions: study
By Maggie Fox, Health and Science Editor
Wed Sep 10, 2008

A new system that assigned a medical "home" to patients, usually a primary care practice, cut hospital admissions by 20 percent and costs by 7 percent, according to a report published on Wednesday.

The program at the privately-held Geisinger Health System in Pennsylvania could serve as a model for U.S. health care reform, researchers reported in the journal Health Affairs.

"This is the direction in which we need to move our fragmented, broken health care system," said Commonwealth Fund President Karen Davis, a board member of Geisinger Health System who helped write the report.

Reforming U.S. health care is a high priority for both Democrat Barack Obama and Republican John McCain. The two presidential candidates agree a major overhaul is needed.

Many reports have shown that Americans pay more per capita for health care, and yet are more likely to die prematurely from preventable and treatable diseases than people in other developed countries.

The secret to reversing this, said Geisinger's Chief Technology and Innovation Officer Dr. Ronald Paulus, is paying primary care practices to look out for patients.

"It provides a centralized place for a consumer, patient, to receive their care," Paulus said in a telephone interview.

The primary care medical staff are available around the clock to refer patients to specialists, provide direct care, help with billing and other queries.

"They remain advocates for the patient and his or her family," Paulus said.

This approach contrasts to the decades-old concept of a "gatekeeper" who would approve all specialist care.

"Their financial incentive was not necessarily to provide the most care. They made the most money if they could get by with a lower amount of care," Paulus said.

The medical home concept instead pays a practice up front to take care of patients and gives them a large bonus if they meet targets, such as controlling blood sugar, cholesterol, preventing heart attacks and screening for cancer.

"They can't scrimp to get efficiency," Paulus said. "We paid in advance for the actual work but we earned the savings on the back side."

"The doctors made more money -- they were happy. The health plans saved money -- they were happy. Patients got more care -- they were happy. But someone has to provide the funding to kick-start the program."

Geisinger's network of hospitals and clinics works with private insurers and caters directly to 2.5 million people in Pennsylvania, many of whom are poorer, older and sicker than the national average.

(Reporting by Maggie Fox; Editing by Alan Elsner and Julie Steenhuysen)
Copyright © 2008 Reuters Limited.