(Note: This was developed just before the 2010 Budget was released.)
The following appeared a few days ago.
Studies: When Doctors Take More Responsibility, Care Becomes Cheaper And Better
KHN Staff Writer
May 04, 2010
Some health policy experts and clinicians have long maintained that, in the effort to reduce health care costs and improve patient outcomes, there's no place like (a medical) home.
A new study in the May issue of the journal Health Affairs seems to validate that notion.
Medical homes — where primary care doctors are held responsible for coordinating care for individual patients – are seen as a model for lowering costs without sacrificing quality. (Related story: Living In A Medical 'Home’).
Dr. Rob Reid and colleagues from the Group Health Research Institute examined the costs and patient outcomes from a team of medical professionals providing care for 10,000 patients at a Seattle-area Group Health "medical home." The conclusion? The medical home produced significant cost savings.
For example, during the two years studied, the team's patients had 29 percent fewer ER visits and 6 percent fewer hospitalizations compared with other Group Health clinic patients. There were start-up costs — $16 per patient per year — and results took a couple years to provide the bulk of the savings. But, ultimately, Reid said that for every $1 it invested in the system, Group Health saved $1.50 by keeping patients out of the ER and the hospital. And the medical home patients "reported better care experiences" as well.
The strategy is now being expanded to all 26 of Group Health's Washington state medical centers — covering more than 400,000 patients. Reid, in an interview, called primary care "a real team sport where the primary care clinician is the quarterback."
If such plans sound like managed care organizations such as Kaiser Permanente, that's because they have a lot in common, including the primary care doctor at the center. But patients at Group Health can self-refer to certain specialists and the approach rewards doctors, not simply the organization, to improve health outcomes.
There's evidence that the medical home, "works and works very well," said HHS Secretary Kathleen Sebelius, at a Tuesday Health Affairs briefing. She also noted that primary care will be important to transitioning to a lower-cost health care system in America. But historically, it's been difficult to attract the necessary workforce needed to provide that type of care. "The reimbursement system clearly has penalized primary care providers over the last several decades," she said.
More here:
http://www.kaiserhealthnews.org/Stories/2010/May/04/medical-home-shorttake.aspx
It seems that this approach is really working and is cost effective in the US. The parts of the model that are workable in OZ certainly need to be applied as we press forward with the planned Primary Care Reforms.
If the budget leaks we see here are close this may be a much more effective attempt that the earlier Hospital Reforms.
Every doctor's practice to get a nurse
- Sue Dunlevy
- From: The Daily Telegraph
- May 09, 2010
Key Points
- Every practice to get full-time nurse
- Nurses to lead medical revolution
- GPs to concentrate on complex care
EVERY doctor's practice in the country will get its own nurse to help treat patients, make home visits, write prescriptions and co-ordinate follow-up care, under a medical revolution in tomorrow's Federal Budget.
Each GP will be eligible for $25,000, worth up to $75,000 a year to a three-doctor practice, enough to hire a full-time nurse.
The nurses will lead a revolution in healthcare, teaching patients with chronic problems like diabetes and heart disease how to manage their conditions, dressing wounds, and carrying out asthma tests and vaccinations.
They will also carry out pap smears, test blood sugar and cholesterol and co-ordinate follow-up care with specialists and health carers.
The care they provide is expected to come at no cost to the patient and it will free up GPs to carry out the more complex medical care.
Currently, government incentives for employing nurses are capped at $40,000 per practice and only apply in rural areas or those with a workforce shortage. About 40 per cent of practices do not employ a nurse.
More details here:
Let’s hope this has been properly planned and the necessary Health IT support has also been factored in! (Post budget comment – we now know it wasn’t. Personal EHRs were funded to some degree – not provider systems apparently)
David.
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