Knowing who your PCP is in the medical home

Integral to the very concept of the patient-centered medical home is the need for a very real, very concrete, one-on-one relationship between the patient and his or her primary care provider.

No matter who this is, the patient needs to know who their internist, or gynecologist, or pediatrician, or nurse practitioner, or other primary care provider is. Nothing can replace this, and everything else about the patient-centered medical home is designed to augment this relationship and help it flourish.

Nothing can substitute for this relationship, this long-term, mutually respectful relationship, that when successfully built and nurtured helps patients move towards a state of better health.

This relationship is built on the very foundations of the patient-centered medical home: quality, continuity, access, and transitions.

Now, one might think, of course, everyone knows who their doctor is. That kindly face you see at every office visit, the gray haired old doctor who has seen you through many illnesses large and small, the pediatrician who watched you pass from infant to toddler to teenager to adulthood.

Yet in many health systems, especially resident-based practices, this is not the case. Some are set up on a first come, first served basis. You need to be seen today? Here is who you will see. An acute visit? Your doctor’s schedule is full, but we have a walk-in provider who can see you. Want to schedule an annual? Next available is 6 months from now.

Not very conducive to relationship building.

At our resident-based practice we recently changed to a new scheduling system that is completely separate from our EHR, and we have discovered that it does not have the ability to identify the primary care provider (PCP) in its templates. Registrars making appointments hope that patients know who the PCP is, or they can guess from the most recent visits in the record.

Begging for discontinuity.

Access to your provider, being able to see who you want to see when you want to see them, leads to improved patient satisfaction and better quality.

Studies have repeatedly shown that a PCP will order less testing for almost any given complaint than an interim provider who does not know the patient. Those headaches? No need to scan again. That abdominal pain? No need for blood tests.

Sometimes the payoff from the long-term relationship of PCP and patient is rewarding in ways both tangible and unfathomable.

And those critical transitions, moving from inpatient back to outpatient, having your own PCP there to pick up the reins of your care, can make all the difference in the world.

As described in a previous column, we have been dealing with the forced discontinuity of a resident practice by building teams to care for patients, with the PCP at the center and the other residents in their “pod” fleshing out the core. Our residents come to practice in 2-week ambulatory blocks, and then are away for 6 weeks. We have tasked the residents to create continuity by handing off active patients to the next member of the pod coming on service, and helping the patients understand that this pod member is the “equivalent” of their PCP for all intents and purposes.

We have created special color “pod pamphlets” that have pictures of the whole team, the resident PCP, the other pod residents, responsible supervising attending, staff supervisor, and practice NP. Useful information such as available appointment dates, patient portal website, and phone/fax numbers are there for patients to help them feel like they really have a team behind them, with the PCP at the helm.

We are studying the “continuity index” (what percent of visits are with PCP or pod mates) to see if enforcing this can really improve quality and patient and provider satisfaction, and maybe even improve outcomes.

We have been building up our transitions program, adding formal structure and dedicated personnel, to get patients right after discharge back to the care of the PCP (or pod), and hopefully even prevent some of those dreaded less than 30 day readmissions.

Enhanced ability to reach your PCP via our EHR’s secure patient portal will also help this relationship. As everyone knows, getting a message to your provider and getting some healthcare back can be a daunting process. Phone tag is our lives. But even the reassurance and recommendations given over the Internet can help heal many wounds.

Open access and advanced scheduling may in the near future allow even more continuity, helping patients get all the care they feel they need.

Knowing who your PCP is, and feeling like they are looking out for you and are there when you need them, will allow the patient-centered model of care to thrive and evolve, with us standing right by our patients’ sides.

Fred N. Pelzman is an associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, New York. He blogs at Building the Patient-Centered Medical Home

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  • Deceased MD

    I think the Kaiser commercial is a little catchier than this.

    • PCPMD

      Actually, matching a patient with their doctor is one of the most important initiatives we have at Kaiser. While a patient will never be denied an appt with someone else if that’s what they prefer, we bend over backwards to try and make sure they are seen by their PCP (90% of the time within 24 hours (assuming its a non-emergency, which generally gets worked in), and 80% of the time within an hour of their choosing). It leads to better care, happier patients and lower costs.

      • querywoman

        I don’t trust Kaiser anywhere! I had them briefly in Texas, and they nearly killed me.
        Their shenanigans got them run out of Texas!
        After my Kaiser fiasco, my favorite doc for a while was an osteopathic GP not too long out of medical school at a minor emergency center. He told me that it costs HMO’s money to let you see a specialist, even their own specialists.
        Kaiser did lead to Governor Bush signing the 1st legislation that really regulated HMO’s, and I believe other states adapted similar measures.
        Texas is the socially most chinchy of all states, and perhaps it realized that penny pinching HMO’s caused the public to pick up the slack.

      • Deceased MD

        Oh I wasn’t thinking of the Kaiser medical system. I was thinking of their hair brained ads. My fave is “Thrive” where a geriatric guy is having a joyride on a motorcycle looking like he’s headed for an ER.

        • querywoman

          That dude sounds like a poster child for Future Organ Donors of America.

  • whoknows

    I still don’t know what a PCMH actually is from reading this. Anyone know what the gimmick is this time?

    • Guest

      A “patient centered medical home” is where each patient technically has a primary care physician, but they’re never allowed to see them. Instead, they’re shunted off to an ever-rotating cast of midlevels and “allied health professionals” like doctor’s assistants, nurses, dieticians, physical therapists, etc.

      • whoknows

        Ever rotating? So the patient does not even stay with the same physical therapists or any of the midlevels you mentioned? what’s the so called benefit?

      • southerndoc1

        Actually, PCMH stands for payer-centered medical home. The two goals are 1. To transform a medical office into a data collection center, and 2. To gradually accustom the patient to the idea that they will no longer be allowed to see a doctor.

        • whoknows

          I am sorry things have come to this. But it seems like you always say it like it is. Your comment really puts things in perspective! But I wanted to ask you about this part.

          “The two goals are 1. to transform the medical office into a data collection center,”

          How is this any different than the way things are now with data collection? And BTW how is it being used and how do they make it legal?

          • LeoHolmMD

            It involves much more intrusive questioning. Submission is automatic. It’s legal because of HIPPA, which gives all corporations the right to have a hay day with your data. There is little governing how it can be used: everything from advertising to adjusting insurance rates to general snooping, research, whatever. We should begin every patient visit with: “You have the right to remain silent….”

          • whoknows

            Just read this one. You are not kidding. About the right to remain silent…

        • Claire

          “That the primary care societies fell for this scam is pathetic beyond words.”
          ABSOLUTELY!! I think docs are going to have to learn to be a lot more savvy and not trust as much. I know it’s hard when you go to school to be a doctor to get out of training and then find out you have to be a business person too, but I also cannot believe the PCPs fell for this. Like it or not, doctors are going to have to learn to be advocates for themselves, their patients, their practices and the profession.
          It’s time to climb down out of the ivory tower and into the trenches.

          • buzzkillerjsmith

            Saying that we fell for it is kinda like saying the serfs in Russia fell for serfdom. Like it or not, serfs are going to have to advocate for themselves and climb up out of the ditch and uh, into the trenches.

      • buzzkillerjsmith

        Beautiful. I’m going to steal your first sentence and make people think I thought of it. Sorry.

  • Claire

    “Resident based practice?” “handing off active patients to the next member of the pod?”. “Pod pamphlets?”. I don’t even know what that is really supposed to mean, but I know it is NOT primary care. So. . .you have a PCP, whom you never see. . .and every time you make an appointment you see a different interim less experienced physician or some other mid-level provider who knows absolutely nothing about you other than what is in the EHR, but you never actually see your PCP? What is the difference between that and going to the CVS/Walgreens minute clinic every time are sick?

    “Useful information such as available appointment dates, patient portal website, and phone/fax numbers are there for patients to help them feel like they really have a team behind them.” Really?. . . so I can get online and call a phone number, where no one EVER returns calls and that is supposed to make me feel like I have a team behind me?

    Only a teaching hospital would think up something as ludicrous as this and then have the gall to call it a PCP when it is really just overpriced doc in a box health clinic.

    • May Wright

      All think talk of “pod pamplets” and “pod residents” makes me think of nothing so much as the movie Invasion of the Body Snatchers. Silly, but there it is. I want to call out in a scary voice, “BEWARE THE POD PEOPLE!”

      /sorry, I’ll settle down now.

      • querywoman

        May, how gruesome and how true!

  • azmd

    A “pod???” Isn’t a pod the term one uses to refer to a group of whales?

    • querywoman

      “Pod” is also an offensive term! What’s wrong with, “medical practice group?”

      • azmd

        Probably it didn’t sound as cool as “pod” did to whomever was devising their practice structure.

  • querywoman

    I just hate the term, “PCP.” Whatever happened to the term, “family doctor?” How did medicine get divided into “adult” or “internal medicine” and “child” or pediatric medicine anyway?
    I’d really like to know, even though I write this as an adult who prefers to go to an internist so I don’t have to deal with screaming, sick kids running loose in the lobby.

    • Deceased MD

      Well said. There use to be specialties called Internal Med and FP. Now it’s dumbed down and even docs on this board use the lingo of “Primary Care” including myself. It’s all part of mangled cares brilliant strategy as you point out. You never think about anyone’s qualifications because they are now “PC”.

      • querywoman

        Glad you like it, Deceased MD. Why not just the term, “my doctor?”
        I see a cornucopia of specialists now. I consider my endocrinologist my main doctor, since I have several problems under his specialty, and am doing quite well with him now.
        I am probably stable enough a GP (sounds so much better than PCP!!!) could maintain me, but I like my specialists a lot. I absolutely need my dermatologist and endocrinologist. I refuse to do any kind of managed care that limits my access to derms and endos.
        I respect the GP’s mucho!

    • NPPCP

      Hey Query,
      I completely agree with you AND Deceased below. The following is just food for thought – just as physicians do not like being called “PCPs”, Nurse Practitioners do not own the title “mid-level”. I NEVER use the term PCP for a physician unless they use the term “mid-level” for me. Then I am quick to call them a provider; this is as equally offensive as “mid-level” is to NPs. In my opinion, we should call everyone what they prefer to be called. I am just as much a provider as the physician who uses the term “mid-level” but do not want to be considered a physician. The problem is easy to solve – everyone take back your own professional title and call other healthcare professions by their preferred titles as well; if you don’t I can guarantee we will all end up being “providers”.

      • querywoman

        You won’t be surprised that I find the term “mid-level” just as offensive. PCP and mid-level don’t even say what you people are.
        A mechanic is a mechanic is a mechanic, even though the insurance industry has also corrupted auto repair.
        Attorneys are also lawyers, which is fine.
        I totally blame insurance companies for this monkey business.
        I have a semi-worthless English degree, which included studying linguistics. English is a naming language, meaning that a lot of the words are devoted to naming things.

      • querywoman

        Why don’t you call yourself ZombieDoc since you are a dead man working?

  • southerndoc1

    “Knowing who your PCP is, and feeling like they are looking out for you and are there when you need them, will allow the patient-centered model of care to thrive and evolve, with us standing right by our patients’ sides.”

    Once again, the peerlessly clueless Dr. P goes the wrong way around the block to get to the house next door, and now considers himself qualified to give directions to the rest of us.

  • querywoman

    Gracious! I think I hit on something. Why don’t you all of you frustrated healers petition the government and the insurance companies to stop calling you, “Primary Care Practitioners,” and, “Midlevels?” The term, “PCP,” implies an insurance company slug, beholden to profit-mad bureaucrats.

    If you want your respect back, get some real job titles on paper!

    Can someone expound on how adult medicine and child medicine got separated? Some kids keep on going to their pediatricians long into adulthood.

  • querywoman

    I receive medical services from physicians and nurse practitioners. I haven’t seen a physician’s assistant in years. I do not receive medical care from a Primary Care Provider or a midlevel. I do not think of any of my health care providers as such! Yuck!