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How to Make a Medical Home Deliver

Philip Betbeze, for HealthLeaders Media, September 19, 2012

This article appears in the September 2012 issue of HealthLeaders magazine.

Patients would like to think that their providers won't hurt them, that providers are coordinating their care, and, in an environment where patients are paying more out of their own pocket, that providers aren't wasting their money. Those are several factors that are supposed to improve under the medical home philosophy, but there are others that patients care more about—notably, their satisfaction. Economics is one reason hospitals and physician practices often evaluate the medical home somewhat differently. Medical home certification is a designation to be sought for prestige and reimbursement incentives from payers. It's also an advertising slogan. It's a way to achieve uniform clinical standards. But does something get lost in translation? Some leaders think so and are working to ensure that what the patients experience and internalize about their medical home matches what the organization thinks it's delivering.

Gradual transition
Thomas Jefferson University Hospitals in Philadelphia began a transition to the medical home framework in its owned outpatient medicine group about two and a half years ago. Barry Ziring, MD, director of the division of internal medicine at the three-hospital system, has led much of the transition and says the impetus began with a desire to change the way the patient interacts with his or her primary care provider, but was also fueled by the knowledge that many of the highly trained, highly paid employees in its practices (especially physicians), were spending valuable time on patient needs that had little to do with actual clinical care.

"Most patients were seen by a physician for a 15- or 20-minute office visit and it was essentially the physician's primary responsibility to take care of the majority of the patient's needs," says Ziring. "Those needs are medical, but they are also psychosocial and administrative and insurance. A 15-minute visit isn't sufficient to have all those needs addressed—the problem being that the medical needs came almost at the end of the appointment."

In fact, that was only one problem among the dissatisfiers experienced by both patients and providers. Recognition of this dissatisfaction led to fertile ground for planting the seed of change among practitioners. In fact, the overriding goal in the evolution of the medical home, says Ziring, is to have everyone at the physician office functioning at the top of his or her license—that is, that they perform the work they were trained to do, work  that no one else can do better. That's simple to say, but much more complicated to administer, especially in organizations where patients have come to expect the physician to address all their needs, and where practices may not have the expertise or the mix of specialized employees to provide the other services patients expect.

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