Dysfunctional System Leads One Family Physician to Transform His Practice

Ask anyone who's ever built a house, and you'll likely hear a tale of an arduous task that took longer than planned. What begins as a pleasant daydream about a fourth bedroom, a three-car garage or a screened-in porch often turns into a quest for the right floor plan or a reliable contractor and then nearly stalls out in endless decision-making and constant owner oversight.

The day the house is completed, the family moves in and maintenance begins.

The same can be said when a family physician decides it is time to build a patient-centered medical home (PCMH) practice. Just ask Tracy Hofeditz, M.D., who, together with his partner FP Kristin Everett, M.D.; a full-time nurse practitioner; and a cadre of staff members, manages the health care of some 3,100 patients at Belmar Family Medicine here.

Back in 2005, Hofeditz says he was discouraged about the way he was practicing medicine -- so much so that he considered ending his career as a family physician. His practice was just another cog in, as he still calls it today, America's "complex and dysfunctional health care system."

However, when Hofeditz read the 2004 Future of Family Medicine report (30-page PDF; About PDFs), the information in the report opened the proverbial barn door by making a strong case for a family medicine revolution.

"I knew then that I wasn't the only one who recognized that there was a problem with the way primary care was delivered in the United States," says Hofeditz.

He was torn between feeling responsible for the well-being of his patients and knowing his own self-preservation was at risk. "I felt like the driver of a car headed for a cliff; I had a chance to get out of the car, but my patients didn't. That's when I decided to be part of the solution."

Leaving the 50-provider primary care group with which he'd been affiliated and setting up an independent practice in a new location was a big decision for Hofeditz. "Moving the practice had psychosocial importance to me," he says. "It indicated breaking away from the past and establishing a new direction for a new future."

In addition, Hofeditz knew instinctively that he would need the managerial freedom to make big decisions about the necessary practice changes that lay ahead.

The work involved in building a PCMH is not to be taken lightly, Hofeditz cautions. "This cannot be accomplished over the course of a long weekend. Becoming a patient-centered medical home begins with a couple of years of attitudinal and cultural adaptation."

Publication of the AAFP's Joint Principles of the Patient-Centered Medical Home in 2007 was a starting point for Hofeditz's conversion. "Once the PCMH was defined by the joint principles in 2007, we were off and running," he says. That blueprint was further defined by the 2008 standards for PCMH recognition developed by the National Committee for Quality Assurance (NCQA).

Fast forward to 2009, when Belmar Family Medicine was recognized at the highest level -- a level three PCMH -- by the NCQA. That recognition allowed Belmar to participate in the three-year Colorado Multi-Payer PCMH Pilot, which paid financial incentives averaging $4 to $5 per patient, per month to participating practices.

Although April 30, 2012, marked the end of that pilot, it was not the end of Hofeditz's passion for the patient-centered medical home model of care.

"My practice thrives in this model. I've done better financially in the last three years than ever before, and I can prove to anybody that my practice provides better care, too," he says.

That's important because too many physicians believe that the burden of practice transformation -- and most certainly the lack of adequate payment -- makes the PCMH model unattainable, according to Hofeditz.

But he says, "I'm putting the energy into it because I want a brighter future for my practice and my patients."

Best of all, notes Hofeditz, "Delivering patient-centered care has rekindled the joy of practicing family medicine."

Editor's Note: Come back next week for part two of this series and learn how Belmar Family Medicine went about making the practice changes that enabled it to become one of the first primary care practices in Colorado to earn patient-centered medical home recognition.