The Medical Home -- What's In It for Me?

Make no mistake, the buzz surrounding the patient-centered medical home, or PCMH, that is coming from Washington and state governments these days is really about the need to transform the way primary care is delivered in the United States. Although the promise of better payment for primary care is on the table, it probably will be linked in some way to a set of capabilities -- some of which your office may already have in place.

So, why should you go to all the trouble of transforming your practice into a PCMH when nobody really knows what a new payment system will look like? Incorporating the PCMH into your practice can help your patients, and it can increase your satisfaction level and that of your staff members.

The basic tenets of the PCMH call for evaluating the quality and level of service you deliver, the organizational efficiency of your practice, the work environment for you and your staff members, and your use of technology. Measuring and assessing these areas can provide opportunities for improvement in most family medicine offices.

Currently, patients have no reliable way to judge the quality of the medical care they receive. They must trust that they are getting the right advice and treatment recommendations. They must look at the physician's communication style, listening skills and the ability of a physician to provide what patients need, when they need it. Are appointments available? Does the office staff answer the phone well? Are messages returned or prescriptions refilled on a timely basis? Are your staff members warm, welcoming and helpful? Are you using technology to help with knowledge management and communication? These are all observations patients can make on their own.

To assess the level of quality and service you provide, you must begin to measure both your clinical work and your patients' satisfaction levels. Start by selecting a few conditions that are common in your practice. For most family physicians, the usual list includes diabetes, asthma, cardiovascular disease and hypertension. The AAFP METRIC (Measuring, Evaluating and Translating Research Into Care) program can guide you and your staff through an office assessment and the collection of clinical measures. Patient satisfaction surveys now are available that have been tested and validated to give good feedback to you and your staff about service issues.

Rigorous financial management and attention to how people work together for a common goal are the basics of any successful service business. The medical office is no exception. Depending on your practice size and configuration, you may or may not be involved in managing the business. In either case, you can insist that it be done professionally and well.

The budgeting process can serve as a forecasting tool, allowing you to monitor income and expenses on a monthly basis. The sooner you detect variation from the projected budget, the sooner you can learn why it is occurring and determine a corrective course of action. A good budgeting process helps you make management decisions based on hard data.

It has become very clear that primary care is a "team sport." Both clinical care and office redesign efforts require good teamwork. Working to actively develop team functioning is worth the effort. Great teams spend time talking about how they get the work done and share knowledge and experience. Team members learn when to step in and how to help each other by talking about interactions, roles and responsibilities. Physicians often are isolated from the general functioning of the office because they assume that their role is limited to the direct patient care. It is essential that physicians be part of their office teams and not just the commander.

Working in constant chaos is no fun. People, including physicians, do not do their best work when the work environment is disorganized and dysfunctional. Most of the recommended changes suggested by the PCMH help increase the level of organization and effectiveness in the typical office practice.

Solving everyday problems with a positive, "can do" attitude is far more effective than just complaining. Make sure to address workflow and personnel problems in a consistent, straightforward manner. Task-oriented work groups can solve workflow bottlenecks, wait time problems and delays in service. Process mapping is essential to understand how the system works now and to help find opportunities for improvement. You will build morale and commitment by involving the people who do the work in resolving office issues.

Using information technology to aid in communication, education and knowledge management can help improve and streamline the care provided through your office. Although a fully integrated electronic health record system with all the bells and whistles may be the ultimate goal, you can improve important office functions using a modular approach, as long as the components work together in the end.

Electronic prescribing is the most important step you can take to improve patient safety and reduce errors caused by poor legibility, incorrect dosages or medication interactions. Registries are essential for proactive care of patients with chronic illness. They organize the information you need to make the most appropriate treatment recommendations and ensure good follow-up.

E-mail communication with patients is far more efficient than telephone messaging. Set up a discrete office e-mail address. Monitor and triage the mailbox to route messages to the most appropriate team member who can serve the patient's need. Do not confuse this recommendation with the idea of having all patients interacting with you on your personal e-mail account.

What is in the PCMH for you? Office redesign promises to improve satisfaction for patients, staff and physicians alike. Regardless of how the payment system changes in the future, redesign efforts based on the PCMH will improve both your clinical effectiveness and your bottom line. You might even get home in time for dinner.

Bruce Bagley, M.D., is a former AAFP president and the current medical director for quality improvement for the Academy.