Conflicts noted – both organizations in which I have had leadership roles have endorsed and advocated for testing the medical home.

I attended an excellent discussion of the medical home yesterday.  The idea combines several concepts:

1. Patient care benefits from coordinated care
2. Physicians will provide better systems of care if they receive some compensation for that provision.  By this I mean telephone access, email access, etc.
3. Paying piecemeal for telephone calls, emails and the like is not feasible nor practical.
4. A single global fee for all care might discourage patient visits.
5. Therefore, combining a monthly management fee – which is meant to pay for all our "extra" time – with a fee for service for visits seemed to the ACP to make the most sense.

I like the concept of rewarding physicians for providing access (telephone, email) and hopefully enough money to spend more time with patients. 

The devil is always in the details.  That is why ACP and SGIM are cooperating on demonstration projects.  We are looking at the consequences, intended and unintended. 

Will it work?  I certainly hope that we can use the projects to determine the proper fees so that internists (general and participating subspecialists) can take proper care of their patients. 

This is an experiment worthy of our support.  SGIM is committed to analyzing the projects.  ACP is committed to finding insurance partners to fund the projects.  The two organizations are working closely so that in the next few years we will be understand how such a system might improve or worsen the field.  That being said, outpatient internal medicine has become so unattractive that supporting this experiment seems that last best hope for the field.

And that is my somewhat biased opinion.