Letters: Readers comment on Medical Economics stories

I've always practiced as a PCMH

Thanks to Joseph E. Badolato, DO, and Toby Free, MD, for their comments in the December 25 "Talk Back" section regarding the Patient-Centered Medical Home (PCMH) article ("The promise of the medical home," by Sam J.W. Romeo, MD, October 25 issue). I agree with them: The PCMH is precisely what I have always done.

There must be layer upon layer of staff at the American Medical Association writing new codes, and layer upon layer of staff at the insurance companies devising brand new ways to deny claims. Now, one of our insurance carriers says we are responsible for ensuring that our patients come in for health maintenance exams. When they don't, we are penalized.

Despite all of this, I will continue to soldier on. My patients still appreciate what I do, even if it seems that no one else does.

CHRISTINE M. HAMILTON, DO
Coldwater, Michigan

Primary care investment lacking

I agree with Alan J. Levin, MD's column "Not cost-effective by design" ([The Way I See It], December 10 issue) that we need more prudent evaluation of patient benefit before committing vast amounts of care when the likelihood of improved outcome is minimal. However, the greater issue affecting our healthcare system is that there has been a substantial lack of investment in primary care, preventive care, health education, and chronic disease management.

The lack of primary care physicians to population relative to the disproportionately large numbers of medical specialists bears witness to this. As a result, the health of our population has not been properly maintained, and the amount spent on expansive emergency department, rehabilitation, and long-term care continues to increase. The attempt to rectify this through the establishment of PCMHs and accountable care organizations is a good beginning. However, the investment is relatively insubstantial.

One example of demonstrable success has been community health centers. Community health centers have been a form of medical home to the underserved for more than four decades. Care received at health centers is ranked among the most cost-effective. Two recent reports found that total patient care costs are 24% to 50% lower than other settings and save up to $25 billion annually, according to the National Association of Community Health Centers.

Proper investment in primary care, including the providers of primary care, combined with health education in multiple venues would provide greater improvement in our population's health and reduce overall costs.

NEAL COLBURN, CPHIT
Okemos, Michigan