The Wall Street Journal (March 15, B1) describes a high quality Medical Home at the Westminster Clinic, which is located between two affluent communities (Westminster and Arvada) in the northwest portion of greater-metropolitan Denver, with easy access to the ski-slopes. The combined population of these area is 223,000, 80% of whom are white or Asian, 16% Hispanic and 1.2% black. Household incomes average $63,500, which is 25% above the national average and 40% above Denver’s, and the poverty rate of 9% is less than half of Denver’s. But poor people aren’t allowed into this Medical Home anyway. The practice doesn’t accept Medicaid, which (according to Dr. Hammond, the clinic’s co-owner) “doesn’t pay enough to cover the cost of care.”
So how is it doing? The clinic has installed electronic medical records, offers care coordination and documents its “quality standards.” But with three physicians, two PAs and 20 other staff to care for 6,300 patients, it’s going broke. And that’s with extra support from a foundation that got it up and running, extra fees from patients to cover the overhead (“concierge lite”), which of course poor people couldn’t afford anyway, and extra income from sales from dietary supplements (“but only those backed by evidence”).
We have a crisis in America. There are too few physicians to provide all that is needed and too little money to pay for it. And this can’t be solved by excluding poor people from the system.
We trust primary care physicians to care for us. Why not end this Medical Home experiment and trust them to innovate.