PCMH Offers Faster, Easier Access to Improved Clinical Care

Changes, Advantages Should Be Obvious to Patients, Say FPs Using the Model

February 17, 2009 04:00 pm David Mitchell

Although many patients might not yet know about the patient-centered medical home, or PCMH, family physicians using the model think it won't take long for people in their care to embrace the concept.

"What patients will realize is that we're more patient-centered," says Matthew Collins, M.D., whose practice in Worcester, Mass., plans to apply for recognition as a PCMH from the National Committee for Quality Assurance, or NCQA. "They'll be able to make appointments online, access more health information online, and they'll see that there is a team taking care of them, not just one person that's assigned to them."

Collins says that his practice has set up "patient committees" that meet weekly and provide feedback as the practice transitions to the new model.

Ramona Seidel, M.D., of Arnold, Md., says she has used a patient-centered approach since starting her practice in 2005. She implemented an electronic health record, or EHR, system in 2006 and started offering virtual office visits, known as e-visits, in 2007.

"In comparison to the practices that patients were using before coming to me, they like the easy access to appointments, as well as the access to the physician directly via e-mail," says Seidel, who plans to start offering group visits this year. "I believe that access is the key to making it a better system. We are striving to remove barriers to care by putting fewer people between the patient and the physician. There is less chance of communication failure when fewer people are involved."

Improving the lines of communication, she adds, should help cement relationships between patients and their physicians.

For Susan Andrews, M.D., of Murfreesboro, Tenn., implementing her EHR system was just the beginning. She says her practice offers e-visits and open-access scheduling. Through the practice's Web portal, patients can see their charts, get test results and communicate with physicians.

Andrews says her practice also uses a patient registry, which has helped 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," she notes.

Joseph Mambu, M.D., of Ambler, Pa., says patients with chronic conditions have benefited greatly from the PCMH model he uses in his practice.

"By customizing our (EHR) to include disease-specific goals that can be individually set for each patient, we are able to give patients printouts at the end of their visit with all the information that their provider reviewed with them," he explains. "After they return home, they are able to read and review what was discussed, since it is well known that many patients do not remember everything their doctor told them."

Denis Chagnon, M.D., of Latham, N.Y., says improved communication between primary care physicians and subspecialists also will enhance care.

"We hope to be able to spend more time with the complex, multiple-problem patients and better coordinate their care, improve communication with their caregivers and other specialty consultants, and prevent unnecessary or duplicate testing that so often happens in today's hectic world of multiple specialist involvement," Chagnon says. "We hope to establish a better relationship with our subspecialists and get them to understand what we are trying to do as a medical home."

He adds that his practice, which hopes to achieve NCQA recognition as a medical home this year, also plans to identify subspecialists who "do not provide appropriate, cost-effective and evidence-based care, and either educate them or eliminate them from our choices" when referring a patient.

Archie Coupe, a 62-year-old patient of Chagnon's, relates how the family physician coordinated his care when he needed back surgery and after postsurgical thrombotic complications arose.

"Dr. Chagnon was in the middle of discussions with many other doctors," Coupe says. "He took it upon himself to get me in front of specialists that could answer my needs. He got my surgery moved up 10 days because he thought it was imperative."

Coupe, who has been a patient of Chagnon's for more than 30 years, says he has definitely noticed a difference as the practice has transitioned to the PCMH model.

"Before I was a person, but I also was a number," Coupe says. "Now I feel like I'm more of a person. The attentiveness of the staff is there from the minute I come in until I have my blood work done. It seems like everyone is on the same wavelength, and they know why I'm there."

It's that very focus on the patient that has Mambu convinced the PCMH model can fix what he terms a "broken" health care system.

"I thought the HMO movement in the 1980s and '90s was the answer," he says. "I was wrong. Primary care doctors should not be gatekeepers. They should be facilitators, and that's what the medical home design permits."