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Tuesday Jan 19, 2016

Patient Perspective Vital for Practice Improvement

When my practice was planning to move to a new facility, we involved most of the people you might expect -- architects, builders, consultants, etc. Our new office includes all the modern technology we need in a patient-centered medical home (PCMH).

But as one of my colleagues likes to say, it's not patient-centered until the patient says it is. When we asked members of our patient advisory board for feedback about the new office, they offered perspectives we had clearly missed in the planning stages.

"There's no place to hang my coat," one man said.

Although we had put exhaustive time into considering what two family physicians, a physician assistant and office staff would need, we had failed to consider a basic amenity -- hooks on the doors -- that patients want in an exam room.

Today, we strive to put the patient at the center of everything we do, and payers need to acknowledge that work. Our small, rural practice achieved level three PCMH recognition from the National Committee for Quality Assurance a few years ago, and it's changed the way we do things. We extended our hours and added open-access scheduling. We added a health coach and adopted team-based care. We're doing more tracking, which means we're doing a better job at both providing preventive care and following up.

Our patient advisory board has been invaluable. The group meets monthly and provides direct feedback that not only helps us solve problems, but in many cases alerts us to their very existence. For example, when we implemented a new phone system, calls were going to voicemail too quickly rather than rolling to other staff members. We weren't even aware of the problem until our patient volunteers voiced their frustrations.

It’s all about the patient experience, and people want and need to talk with other people -- not machines.

Of course, all of these factors related to patient-centered care take additional time and effort, and that's one of the points I made in a recent meeting with HHS. On Jan. 14, I represented the AAFP in a roundtable discussion about patient engagement. The Academy was the lone physician organization at an event that also included representatives from consumer and patient advocacy groups, payers, health systems, a nurses' organization and an electronic health records vendor. HHS wanted to foster a discussion about "how engaging and empowering individuals in their health is an essential part of transforming our health care system."

More than one-third of AAFP members already practice in recognized PCMHs, but I said that if HHS and other payers truly want to move the needle on patient engagement, they must pay primary care physicians appropriately so practices can afford to make needed changes.

As we move from a payment system based on quantity of services delivered to one based on quality of care provided, payers must recognize the significant investment they are asking our practices to make. When that happens, we can move beyond discussions of the triple aim -- enhancing the patient care experience, improving population health and reducing costs -- to focus on a system that embraces the quadruple aim by adding the goal of improving the work life of health care professionals.

Mott Blair, M.D., is a member of the AAFP Board of Directors. 

Posted at 02:25PM Jan 19, 2016 by Mott Blair, M.D.

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