The state stopped by to see us the other day. Wow, that sounds ominous. No, really, I mean it felt like the entire Empire State: multiple people from multiple offices of New York state government, department of health, office of compliance this, oversight that, all with a vested interest in how things have been going (i.e., how we have been spending their money) in our patient-centered medical home resident pilot program. A few ...

Read more...

Actionable items. Today I decided to take a look at one of the dashboards that the information technology (IT) department built for our electronic health record, to help us a look at our patients enrolled in the multiple registries of diseases and conditions we are following for the patient-centered medical home. I booted up the program, and with just a couple of clicks of the mouse the program began running, checking with ...

Read more...

My morning practice session started out with a few patients arriving early, so I was able to get a jump on the day, and it looked like I was going to actually be running on time. As I was walking from one exam room to the other, my administrator came down the hallway, grabbed my arm and said, "Can I have you for a minute?" It seems that a group of systems ...

Read more...

During her annual physical exam, one of my patients recently asked me, "Are urgent care centers any good, Dr. P?" She recounted an incident a few months earlier where she awoke with an acute illness and was sick enough that she felt she needed to receive care -- at least some medical attention -- more imminently than she could get from waiting to speak to my office in the morning. She ...

Read more...

Opening my mail today, there are multiple letters from multiple insurance companies, reportedly communicating valuable information to me about my panel of patients that they cover. One of the envelopes holds two single sheets of paper, one of which contains a listing of my panel of patients and the providers they have been referred to over the past quarter. The second sheet, mysteriously, contains only a single line: This page intentionally left ...

Read more...

It's a cold and rainy morning, and we've traveled to the middle of Central Pennsylvania to see a presentation at a conference about a patient-centered medical home product produced by one of the largest health care systems and insurers of the region. There are clinicians and administrators from all over the eastern half of the U.S. (plus one from California), and also a large contingent visiting from the U.K., on a ...

Read more...

I'm feeling meaningfully used today. Once again, we are faced with another set of administrative hurdles, boxes that need to be clicked, tasks that need to be completed, all in the name of demonstrating that we are meaningfully using the electronic health record in which our practice and the federal government have so heavily invested. An "eligible professional summary" arrives in my email, with lots of bars with lines, and green checks ...

Read more...

"Here you go, doctor." My patient with incredibly well-controlled type 2 diabetes hands me his fingerstick log at his regularly scheduled office visit. Despite his multiple medical problems (congestive heart failure, coronary artery disease, chronic renal insufficiency, and gout, among others) his sugars have been incredibly well-controlled over the past several years. Page after page of scrawled numbers, tiny smears of his blood on the pages, his fingersticks range from 90 to ...

Read more...

Greater discontinuity equals greater dissatisfaction. On Wednesday afternoon, one of the residents stopped in my office to talk about a patient he had just gotten off the phone with. It was a patient of his who had asthma and a recent upper respiratory tract infection for which she had received treatment at an urgent care center with an oral antibiotic and a course of steroids. She told him that she was still ...

Read more...

At a recent faculty meeting, the attendings in our practice were asked about their availability for new patient appointments. The vast majority reported that due to time constraints and patient volume, they had closed their panels to new patients. For those of my partners with open schedules, the wait for new patients to be seen was averaging 2 to 3 months, a few up to 6 months. The time to the ...

Read more...

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 ...

Read more...

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 ...

Read more...

"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 ...

Read more...

"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 ...

Read more...

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, ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

Most Popular

Join 150,000+ subscribers

Get the best of KevinMD in your inbox

Sign me up! It's free. 
close-link
✓ Join 150,000+ subscribers 
✓ Get KevinMD's 5 most popular stories
Subscribe. It's free.