PCMH Profile

FP Finds Move to PCMH Well Worth Investment

February 17, 2009 04:15 pm David Mitchell

Susan Andrews, M.D., of Family Practice Partners in Murfreesboro, Tenn., says she's a strong proponent of the patient-centered medical home, or PCMH, and continuously tries to find ways to make the model work even better for her practice and her patients.

The practice, which was selected to take part in the TransforMED national demonstration project, or NDP, in 2006, has a robust electronic health record, or EHR, system and uses it to offer patients more choices in how they receive their care. In addition, the practice has implemented a number of the other components of the PCMH, including team-based care, group visits, patient registries and same-day scheduling.

Andrews recently shared with AAFP News Now some of her thoughts on the positive aspects of the PCMH for patients.

Q: What differences or changes do patients see in your practice under the PCMH model compared with what they saw before?

A: Patients understand we'll take care of them when they want to be seen and how they would like to be cared for. They also appreciate getting in and out of our office faster. Patient satisfaction has gone up.

Q: What services do you offer -- group visits, e-visits, open scheduling, etc. -- that might not have been in place before?

A: We had just implemented e-visits before we joined the TransforMED NDP. Via our Web portal, patients can see their charts, get results and communicate with us online. One physician holds spirited group visits with high patient satisfaction.

We've also implemented advanced-access scheduling. The goal is to take care of today's work today. There is no nurse triage. Slots are kept open for same-day appointments, and the scheduler brings in everyone who wants to be seen that day that very day, including physicals if possible. We do sometimes offer online house calls or quick visits using a computerized history-taking system on days that are very busy.

We've increased our patients' responsibility for putting their own history into the computer, either in the office or at home. We've increased nurse responsibility for quality of care. We're using our patient registry more than ever to help identify patients who need extra help improving their health. We continually improve our use of the EHR with an eye on improving efficiency and quality.

Q: How else has your practice changed?

A: The greatest change for our practice has been building robust teams. No longer does the physician work in his or her bunker seeing patients without help or communication with the staff. Each staff member works to the highest level of his or her ability. Standing orders allow nurses and medical assistants to order or perform health maintenance and disease management tasks without direct orders. This has greatly improved quality of care. We huddle at least once a day for a minute or so -- nurse, doctor and receptionist -- to go over the schedule, look for problems, see what data is needed before the visit and see where open slots are.

Q: How long has your practice used the PCMH model?

A: Before we joined TransforMED, we were actively working on quality and had used an EHR for six years, but in 2006, we bought into the TransforMED goal of transforming into a patient-centered medical home. Our overall mind set has changed. We're no longer trying to control the schedule to make it easy on the staff and doctors. We're trying to serve our patients the best way we can instead. In the long run, you do the same amount of work. Why not do it when it's convenient for the patient?

Q: Why do you believe it is a better method than the existing system?

A: The PCMH puts the patient in the middle. We've become more service-oriented than before and know what our vision is. We've been able to make huge strides in reaching our goals of providing high-quality care efficiently.

Many physician practices in the current health care system do not have EHRs, but EHRs are critical to improving quality and efficiency. We've been able to cut back by one and one-half full-time equivalent positions per full-time physician. Plus, we've improved quality from the 50th percentile to above the 90th percentile, according to our data.

Patients have really taken to having Web access. Although they don't use online house calls that often, they like how fast they get results and appreciate being able to message us online. Our workload has gone down because messaging is so much more efficient than phone communication. Patient care also has improved because patients can message us with their sugars, blood pressures and weights, and we can make course changes between visits very easily. I know this has kept some people out of the hospital.

Q: Do you work more closely or better with subspecialists in the PCMH than you did previously, and if so, why?

A: Our subspecialists and hospitalists are now able to see the patient charts online, plus we can send templated referral letters in a matter of seconds. We're also able to import notes from them very efficiently.

Q: Do you have any other thoughts on the PCMH?

A: The patient-centered medical home is not just doing what we did before and defining it differently. It involves changing processes, putting the patient first, involving all the team members in very meaningful ways, looking critically at how things are done in your practice with an eye out for opportunities to make major changes in how the practice is run, and taking the risk of implementing an EHR system and Web interfaces.

The costs are fairly high -- initial outlay for computer systems and software, time involvement, people issues, and other frustrations along the way -- but the payback can be enormous with a more satisfied patient population that is receiving better care in a way that reflects how they want to be cared for.