With the announcement out of Washington about the 2015 budget, much has been made about the apparent presence of significant support for the development of more primary care practitioners in the years ahead. This support includes programs aimed to encourage medical students and residents to choose primary care as a profession, including loan forgiveness packages. Response in the press has already raised issues with this, suggesting that this move would do little ...

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During an afternoon seminar on a new paradigm for lung cancer screening in primary care, my phone chirped announcing the latest MedPage Today bit of breaking news: "Medical Homes May Not Be the Answer." A study in JAMA reported that cost per month per patient had actually increased, and only one marker of improved care was found to have improved after thousands of patients were followed in a large group of patient-centered medical ...

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"Just start work half an hour earlier." This is what the head of the care coordination committee for our patient-centered medical home executive committee work group recommended when we talked about our struggle getting the team together for early-morning pre-clinic huddles. She suggested that if we started our usual practice morning at 8 o'clock we should just have everybody come in at 7:30 to load the dashboards for the morning session ...

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"What's a high-risk patient?" asked our newly hired care coordinator. Interesting question, and, as you would expect, one without an easy answer. One of our patient-centered medical home certifying agencies was performing an audit for recertification, and requested information on our high-risk patient registry, including how patients were identified and assigned to the registry. When you ask doctors or any other providers, we all know one when we see ...

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Standing in the middle of a massive hotel convention center hallway with thousands of people wearing name tags. Not where I usually spend my days. I have been asked to join senior management at a national client conference for the company that is providing patient survey data to our institution, those surveys patients get in the mail asking about their "experience" during their visit to our practice. Everybody here wants the same thing, ...

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Recently a colleague from IT who is working with us on our patient-centered medical home asked me, "when is the rollout date for your patient-centered medical home?" As we have gone through this process for the past six months, I can definitely answer that there is no one day when this is going to happen. We are not going to close the door one night, turn out the lights, shut down ...

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As we've gone through the process of building our patient-centered medical home, we have brought along a little bit of the scientific method. As part of the medical home rollout, we developed an expanded quality improvement curriculum for our internal medicine residents. A series of talks on key topics of the patient-centered medical home has been developed, and several faculty experts have been delivering these to the residents. As a part ...

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Just the other day one of the medicine residents presented a case to me, and mentioned that in looking through the patient's chart he noticed that the patient had undergone a prostate biopsy 1 month prior to this visit, with a follow-up appointment in urology scheduled next month. The result of the biopsy was positive for cancer, but that had not been communicated to the patient. His first instinct, he ...

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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 ...

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Even in its purest form, in the most perfect patient-centered medical home we can create, patients will sometimes need to move beyond the confines of primary care. Each of us in primary care has a point that we choose not to venture beyond, into the realm of subspecialty medicine where we lack the experience and tools and support to fully implement complete care for patients with these particular problems. It may be ...

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