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ACP Embraces Patient-Centered Medical Home 'Neighbor' Concept
Paper Describes Interface of PCMH, Subspecialty Practices
By Sheri Porter
The ACP uses the phrase "PCMH neighbor," or "PCMH-N," liberally in the policy paper. It defines the term as a specialty or subspecialty medical practice that
- ensures effective communication, coordination, and integration with PCMH practices;
- secures appropriate and timely consultations and referrals that complement the aims of the PCMH practice;
- confirms the appropriate flow of necessary patient and care information;
- guides determination of responsibility in comanagement situations;
- supports patient-centered care, enhanced care access, and high-quality, safe care;
- recognizes the PCMH practice as the provider of the patient's primary care; and
- understands that the PCMH practice has overall responsibility for coordination and integration of care provided to the patient.
The paper also addresses the topic of comanagement of patients between the PCMH and the PCMH-N. Comanagement can be handled in one of three ways: with shared management of a disease, principal care of a disease, or principal care of the patient for a consuming illness for a limited period.
The ACP provides a 10-point list of guiding principles for the development of care coordination agreements between PCMH and PCMH-N practices. For example, the agreement should
- define expectations regarding information content requirements and the frequency of information flow within the referral process;
- specify how secondary referrals will be handled;
- maintain a patient-centered approach, including consideration of patient and family choices;
- address situations of self-referral by the patient to a PCMH-N practice; and
- clarify inpatient processes, including notification of hospital admission.
In an interview with AAFP News Now, he cited certain situations -- such as patients in certain stages of cancer care and other severe-stage illnesses -- as examples of the value of the PCMH-N concept. "In those circumstances, the expected roles will have to be flexible enough for both the patients and the physicians involved to achieve the best care," he said.
The ACP also supports the alignment of incentives -- both financial and nonfinancial --between PCMH and PCMH-N practices, as well as future work to develop a PCMH-N recognition process.
"The AAFP has long been in favor of aligned incentives to appropriately develop a high-quality, cost-effective delivery system, because lack of such incentives slows needed changes," said Goertz.
Regarding PCMH-N recognition, Goertz suggested that the topic should be tackled by those most affected by such a system. "Any decisions made should be based on how the best quality of care can be achieved."