Issues in primary care: Medical homes and ethical concierge practices

News outlets report on trends in the primary care workforce, including medical homes and concierge medicine.

In the second in a three-part series on primary care, NPR reports on "a nonprofit regional health care collaborative in Maine that's trying to build medical homes in the state." One goal of the medical home is for doctors "to be able to hand off some of the less specialized — and often time-consuming — tasks to others. The idea, says [Lisa] Letourneau [who heads the nonprofit], is to have everyone ... doing what they are most trained to do. That should best serve the patients and the health professionals." But while "doctors and patients may be happier and healthier" in medical homes, "what will really determine the success or failure of the medical home in the long run is whether it actually saves money." Letourneau "says many of the ongoing experiments aren't focused enough on costs" (Rovner, 8/26). 

The New York Times, in a reported column about the ethics of concierge medicine: "[I]t's hard not to wonder whether it is possible to practice in a way that reconciles concierge medicine with all the ethical concerns. One group of doctors in Boston believes it is possible. And in an article published this summer in the journal Academic Medicine, they argue that it can be done to the benefit of doctors and all patients, boutique or otherwise. Since 2004, the primary care physicians at Tufts Medical Center have offered patients the option of being part of either a traditional general medical practice or a retainer practice." Those who opt for the "retainer practice" have longer visits, 24-hour access to a physician, "comprehensive wellness and prevention screenings and on-time office appointments within 24 hours of a request. But unlike other boutique practices, the retainer fee of $1,800 per year that these patients pay does not go directly to the doctors' coffers. Instead, it is used to support the traditional general medical practice, the teaching of medical students and trainees and free care to impoverished patients" (Chen, 8/26).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.