To the Editor: Dr. Payne1 asked why we did not place reminders on the charts of all women over the age of 65, regardless of the reason for their visit.2 We chose to only recruit women who had an upcoming visit for an annual examination because the annual examination allows extra time to systematically review and address multiple preventive issues.3–5 Providing all preventive services and counseling for all patients would take an average of 7.4 hours per working day,6 and thus would be impractical. Asking physicians to discuss osteoporosis screening and to provide counseling about bone health at times other than a scheduled preventive visit would place an unfair burden on the busy physicians who volunteered for this study. Even if reminders on all charts would increase response rates for osteoporosis testing, they would probably interfere with other care the patients should receive. A key aspect of a medical home is the systematic tracking and registry function that organize clinical information and remind physicians and patients of services needed.7,8 It is clear that the nation needs fundamental payment reforms in primary care to achieve population health.9
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