When Andrew Morris-Singer was in his fourth year of medical school his mother's lungs stopped working.

She was put into a medically induced coma because of an atypical pneumonia, a condition that he said would likely have been caught if she had a "comprehensivist," a primary care physician who coordinated her care instead of several specialists.

Morris-Singer's mother survived. Today, he uses her case to illustrate one of the fundamental challenges in our healthcare system.

The House ended its "lame duck" session with a budget deal that didn't please most physician groups.

The $1.1 trillion budget bill, which was passed by the House on Thursday and is expected to be passed shortly by the Senate, is lacking any fix to the widely hated sustainable growth rate (SGR) formula for physician reimbursement under Medicare. Also missing in action: an extension of the current pay bump for primary care physicians who see Medicaid patients.

When Medicaid expansion came to Louisville, Ky., it created an opportunity for a population traditionally served by public health clinics to receive healthcare through a wholly different mechanism -- and so far that mechanism appears to be reaping benefits.

LaQuandra Nesbitt, MD, MPH, Director, Louisville Metro Department of Public Health and Wellness, made the executive decision to limit access to certain services in public health clinics in an effort to "steer" residents into local patient-centered medical homes (PCMH).

So we've come to the end of another academic year.

New interns have arrived for orientation, with that combination of unbridled enthusiasm and deer-in-the-headlights panic we all remember so well.

Senior residents are wrapping up their lives in residency, preparing to move on to become fellows, hospitalists, or practicing physicians in the community.

And our junior residents have completed their first year of a new quality improvement curriculum, and the eight patient-centered medical home (PCMH) practice improvement projects have been brought to fruition.

Researchers found 17 practices operating as "medical homes" in Pennsylvania significantly reduced costs for high-risk patients -- countering negative results published last month that looked at the same patient-centered medical home (PCMH) pilot.

Last week's column focused on some of the many challenges we've encountered trying to create a more patient-centered transitions program for moving patients from the inpatient setting to the outpatient setting. As we have been going through this process, and through our everyday lives, we realized that another venue with a delicate transition is moving into and out of the emergency room.There are many conditions that we would rather not see in our office and are much more appropriate for triage and care in the emergency department. Acute myocardial infarction, stroke, sepsis.

The Obama administration in 2014 will "double down" on delivery system reform efforts such as the further proliferation of accountable care organizations (ACOs), a White House health policy adviser said Monday.

"The system works so long as it's not just accessible but affordable," Jeanne Lambrew said at AcademyHealth's National Health Policy Conference here, referring to two of the outcomes policymakers hope will result from new models of care.

As regulators and health policy experts try to determine the effectiveness of patient-centered medical homes (PCMHs), one evaluator says they shouldn't all be judged by the same measuring stick.

Instead, those questioning the cost and quality value of PCMHs need to evaluate each model on its own terms, Asaf Bitton, MD, MPH, instructor of healthcare policy and PCMH researcher at Harvard Medical School, said here.

Although Medicare's proposed complex care management billing code might seem like a help to patient-centered medical homes (PCMH), not all PCMH supporters like the idea.

Medicare -- the country's largest healthcare payer -- should move closer toward a per-member bonus for PCMHs and not perpetuate a fee-for-service model that has done little to stop skyrocketing healthcare costs, Chris Koller, president of the Milbank Memorial Fund in New York City, said here Monday.

Medicare understands the value of primary care, but the process of increasing payments to such providers may be more difficult than the program realizes, a former head of the American Academy of Family Physicians said here.

The Centers for Medicare and Medicaid Services (CMS) has for the last 2 years introduced new payment codes to reward services unique to primary care -- a sign these agencies realize the value of primary care.