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Comment & Response |

Did Extra Resources or the Medical Home Model Improve Care?—Reply

Meredith B. Rosenthal, PhD1; Mark W. Friedberg, MD, MPP2,3; Eric C. Schneider, MD, MSc2,3
[+] Author Affiliations
1Harvard School of Public Health, Harvard University, Boston, Massachusetts
2RAND Corporation, Boston, Massachusetts
3Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2014;174(6):1008-1009. doi:10.1001/jamainternmed.2014.763.
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In Reply It is possible that the additional funds provided to practices in the patient-centered medical home pilot had a direct effect on the study outcomes that was not mediated by other changes. The establishment of a patient-centered medical home involves multiple changes to a practice. Thus, studying many variations of the changes would be needed to isolate the contribution of a single component, such as increased payments. We are unaware of evidence that increasing payments to primary care physicians without other changes is sufficient to increase the quality of primary care or to reduce the utilization of acute care.

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June 1, 2014
David U. Himmelstein, MD; Steffie Woolhandler, MD, MPH
1City University of New York, School of Public Health, New York
JAMA Intern Med. 2014;174(6):1008. doi:10.1001/jamainternmed.2014.770.
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