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Group Appointments in Colorado

Posted May 14 2010 4:05am
One of the early indicators of tightening medical access in Massachusetts under RomneyCare was the growth of "group appointments", where a single doctor would see multiple patients simultaneously .

Basically patients give up privacy and one-on-one time with their physician in exchange for getting a timely appointment.

Now such group appointments are spreading to Colorado , as part of the trial for a new health model promoted by ObamaCare known as the "medical home". (Link via @Lucidicus and mtrunner2 .)

Of course, voluntary "group appointments" can be perfectly fine if there are several patients with similar health problems willing to ask questions in front of other patients about issues of common concern. They can be a valuable adjunct to personalized appointments. But they cannot substitute for personal one-on-one time with a physician.

The Boston Globe story includes a video of such a group appointment.

As one commenter in that story stated:
In the group setting, the patients are not allowed to remove clothing for proper physical examination due to the lack of privacy. In the video, Dr. Lindsey is shown auscultating and percussing through the patients' clothing.

As a medical student, I would flunk, that's right, flunk my standardized patient examinations if I even thought of auscultating or percussing through clothing. It is obvious that the lack of privacy even in the cardiology setting restricts the doctor from doing a proper physical examination.
Moreover, while the concept of a "medical home" sounds nice in theory, it can also be easily corrupted to become just another vehicle for rationing.

As Shawn Tully of Fortune magazine wrote last year :
[Under ObamaCare,] Americans buying through the exchanges -- and as we've seen, that will soon be most Americans -- must get their care through something called "medical home." Medical home is similar to an HMO. You're assigned a primary care doctor, and the doctor controls your access to specialists. The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists.

Under the proposals, the gatekeepers would theoretically guide patients to tests and treatments that have proved most cost-effective. The danger is that doctors will be financially rewarded for denying care, as were HMO physicians more than a decade ago. It was consumer outrage over despotic gatekeepers that made the HMOs so unpopular, and killed what was billed as the solution to America's health-care cost explosion.
Under the new "medical home" concept, the task of denying care is shifted from the government to the primary care physician (who may be operating under hidden government financial incentives to reduce referrals and control costs). As we've seen in countries like Great Britain, this pits the physician's interests directly again his patients' interests .

I fully support the concept of integrated personalized health care, where multiple specialists are coordinated by a primary physician working in the patient's best interest -- if patients and their physicians voluntary choose that approach with full disclosure and understanding on both sides.

But if such "medical homes" are made compulsory, then I am deeply concerned that Americans will be subjected to a nasty bait-and-switch, where their care is actually being rationed under the guise of "coordination" from their "medical home".
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