Beauty Health for Life

HOW much for the PCMH?!*

According to Drs. Gill and Bagley, writing in the Annals of Family Medicine, the costs of transforming a primary care practice to a Patient Centered Medical Home should be generously borne by "payers."

While wishful thinking about payers deep pockets is not new, the article has some eye-opening data (with Disease Management Care Blog provided links) on just how much some or all of the elements of a PCMH cost:

a) $1850 per month per practice or $17,000 per physician,

b) $5,600 start-up then $2,200 per year related to the costs of reporting outcomes,

c) $117,000 per physician per year, and

d) up to approximately $15,000 per practice per year for a management facilitator. 

No wonder the DMCBs friends in academia want someone else to pay for it.

In the meantime, companies like this continue to offer a different business model. Instead of rebuilding and equipping an entire primary care practice for a croup-to-guts "transformation," population health (definition here) service providers focus on those patients who are at highest risk and provide a modular combination of in as well as outsourced services. While there is no head-to-head cost comparison of PH vs. PCMH, it would appear that the per patient approach of PH has a competitive pricing advantage.

Stocking up for allergy season

And speaking of outsourced services, the DMCB joins its other colleagues in looking forward to EHRs "meaningful use" criteria go from being meaningless to being truly meaningful.

For an under-recognized example of just how meaningful things will become, check out this interesting blog posting that describes the use of cloud-based EHR-data to follow U.S. allergy statistics.

While the information is interesting on its own merits, think how these data could be used by savvy providers to match allergy "market demand" by "stocking" a "just-in-time" "inventory" of allergy-care services such as patient reminder campaigns (for those with allergy-provoked asthma, "be sure to use your peak flow meter!") extra condition-specific appointments ("your provider with allergy expertise can see you this morning!"), treatments slots (nebulizers and immunotherapy ready to go) and medications (OTCs and prescription meds for the in-house pharmacy).


*Image from Wikipedia

A new study by the Centers for Disease Control and Prevention (CDC) links too little sleep (six hours or less) and too much sleep (10 or more hours) with chronic diseases – including coronary heart disease, diabetes, anxiety and obesity – in adults age 45 and older. The American Academy of Sleep Medicine (AASM) encourages patients suffering from these common chronic conditions to speak with a sleep medicine physician who can evaluate their sleep patterns.

“It’s critical that adults aim for seven to nine hours of sleep each night to receive the health benefits of sleep, but this is especially true for those battling a chronic condition,” said Dr. M. Safwan Badr, president of the AASM. “Common sleep illnesses – including sleep apnea and insomnia – occur frequently in people with a chronic disease and can hinder your ability to sleep soundly. So if you’re waking up exhausted, speak with a sleep physician to see if there’s a problem. If you are diagnosed with a sleep illness, treating it could significantly improve disease symptoms and your quality of life.”

“Some of the relationships between unhealthy sleep durations and chronic diseases were partially explained by frequent mental distress and obesity,” said study co-author Janet B. Croft, PhD, senior chronic disease epidemiologist in CDC’s Division of Population Health. “This suggests that physicians should consider monitoring mental health and body weight in addition to sleep health for patients with chronic diseases.”

In the study, published in the October issue of the Journal SLEEP, short sleepers reported a higher prevalence of coronary heart disease, stroke and diabetes, in addition to obesity and frequent mental distress, compared with optimal sleepers who reported sleeping seven to nine hours on average in a 24-hour period. The same was true for long sleepers, and the associations with coronary heart disease, stroke and diabetes were even more pronounced with more sleep.

“Sleeping longer doesn’t necessarily mean you’re sleeping well. It is important to understand that both the quality and quantity of sleep impact your health,” said Badr. “A healthy, balanced lifestyle is not limited to diet and fitness; when and how you sleep is just as important as what you eat or how you exercise.”

The study involved more than 54,000 participants age 45 or older in 14 states. Nearly one third of participants (31 percent) were identified as short sleepers, meaning they reported sleeping six hours or less on average. More than 64 percent were classified as optimal sleepers, and only 4 percent of participants were long sleepers.