Health care reform is being "fast-tracked" through Congress and some of the proposed changes will result in decreased access to specialists. Among proposed reforms of physician payment for medical services, the Medical Home model has attracted the most attention.

The Medical Home is a system in which primary care providers coordinate all aspects of patients' care and there are incentives to not refer to specialists. In theory, this concept seems attractive and the assumption is that it would save money, but it has not been validated or shown to improve patient care or decrease costs. Indeed, it is possible that it would lead to poorer clinical outcomes and increase costs.

The HMO gatekeeper system (a similar concept) has been tried and failed over the last 20 years, and hence has largely been eliminated by the insurance industry. The Medical Home system is also problematic because there are not enough primary care providers in the U.S. to sustain it.

Medical care by specialists often leads to better clinical outcomes. For example, patients with asthma who are followed by allergists (compared to primary care doctors) have been found in scientific studies to have:

• Fewer emergency department visits (76 percent decrease).

• Fewer hospitalizations (90 percent decrease).

• Fewer sick care visits (45 percent decrease).

• Fewer school and work days missed (80 percent decrease).

• Reduced length of stay in hospital (4 to 2.5).

• Lower medical costs.

Sometimes an anecdote best illustrates a concept. "Jane" is a teenager who was referred to me by a family friend because of uncontrolled asthma. She hadn't slept through the night in months. She was tired during the day and her grades suffered as a consequence. She had seen her pediatrician repeatedly for these problems, didn't respond to treatment, yet she was not referred to an allergist (as recommended by NIH asthma guidelines). Since I took over her asthma care, she hasn't been to the ER, is participating in sports and is leading a normal life.

Proposed health care changes, in a misguided attempt to save money, will lead to more patients like "Jane."

I am not suggesting that most primary care providers don't know what they're doing or don't try hard to help their patients. However, the complexity of today's medical care is mind-boggling. It will only become more complicated in future years, and keeping up with these advances will be more and more difficult.

Before we invest many billions or trillions of dollars in an unproven approach to managing health care, these ideas needs to be field tested to make certain they work. If one of them does work, it should be implemented. But, if they don't work, we need to come up with new ideas before we waste our precious dollars.

Rushing into change and making the wrong decision will have horrible consequences for patient care. Research has shown that the rising cost of medical care is primarily due to technological advances and no present proposal addresses how to get a handle on that issue.

I ask the readers to contact our senators and representatives and advise them to slow down the health care reform process to make sure we get it right. Otherwise, we may be replacing our system with something even worse.

As the bank bailout has taught us, we should not rush into such a huge expense.

Roland Solensky, MD, of Corvallis, is an allergist and immunologist with Corvallis Clinic/Albany Family and Specialty Medicine.