The Alliance for Health Reform partnering with WellPoint sponsored a briefing May 30 on Capitol Hill to discuss the Patient-Centered Medical Home (PCMH) in terms of the promise and the reality.
The briefing with Ed Howard of the Alliance moderating, included panelists Amy Gibson, COO, for the Patient-Centered Primary Care Collaborative, Pauline Lapin, Senior Advisor for the Center for Medicare and Medicaid Innovation and Deputy Director for the Seamless Care Models Group, Amy Cheslock, VP of Payment Innovation for WellPoint, and Mark Frazer, MD an independent physician from Middletown Ohio.
Dr. Frazer discussed in detail the successes and challenges that faced his practice when transforming into a PCMH. The practice located in Middletown Ohio is a blue collar Appalachian community with an industrial base of steel and paper manufacturing.
He explained that in 1985, his practice Summit Family Physicians Inc.at summitfamdocs@yahoo.com was formed in the community and today remains an independently owned practice. In 2011, the practice signed an EMR contract and went live the same year, plus in December 2011, the practice achieved meaningful use Stage 1.
In total, the practice is treating six thousand patients where 45 percent of the patients are over 65 years old and a number of patients are over 80. However, physicians still make daily hospital rounds and care for newborns. The practice includes three board certified physicians, one certified nurse practitioner with a position that is one-half clinical and one-half administrative, plus there are 18 other employees.
In September 2012, the practice was selected to take part in the CMS Comprehensive Primary Care (CPC) Initiative. Primary care practices that choose to participate in the initiative are given resources to use to better coordinate primary care for their Medicare practices. The practice is currently in the second year of the four year CPC program.
The practice has initiated a number of enhancements to provide better patient care:
- Open scheduling is provided daily for 30 percent of the appointments
- 24/7 MD phone access is available
- Payment policy for delinquent accounts has been reviewed and modified
- Hospitalized patients are contacted within 48 hours after discharge to make the adjustment easier
- Emergency department visits are followed up with a phone call for care needs
- Education is provided to inform patients on practice access and capabilities
- Referral tracking is available to specialists to ensure timely access and follow-up
- All patients are risk stratified to keep the staff alert to care responsibilities
- Patient education classes have been established by partnering with pharmaceutical companies
- Community resources have been aligned with patients’ needs
- Outreach is provided to patients that are not seen in the office for chronic disease management and preventative care procedures
As Dr. Frazer pointed out “There are benefits to change in terms of employee satisfaction in meeting more patients at the point of need, employees are able to work at a higher level of responsibility, patients receive more comprehensive quality care, support is available from like-minded practices, and support is also available from the CPC faculty both locally and nationally.
The doctor explained, “Change is difficult, energizing, and exhausting.” For example, open access reduces scheduling efficiency, added care responsibilities reduce the number of patient visits available, and since more people are required on the staff, it costs more to run the practice.
There are additional challenges since the practice needs to be able to receive quality data from hospitals and insurers to empower change. In addition, all components of the care community need to be connected to provide comprehensive care.
As Dr. Frazer summed up, even with the challenges practices face, there is the need to move forward with the PCMH standard of care. This can be accomplished but in order to move forward, primary care providers must be at the center of the medical care delivery system. This requires that the primary care physician shortage be addressed and resolved and compensation for care management must include all patients.