Patient-Centered Medical Homes Aim to Keep the Focus on Serving Patients

Dr. Matthew Cory, left, holds 6-month-old Piper Overholt as he stands next to Jen Overholt, center, and her other children, from left, Reese, 14; Carter, 18 ; Ellie, 8; and Ainsley, 4, at Lakeside Pediatrics in Lakeland recently.

ERNST PETERS | THE LEDGER

By Robin Williams Adams
THE LEDGER

Published: Friday, July 4, 2014 at 10:33 p.m.

Last Modified: Friday, July 4, 2014 at 10:33 p.m.

LAKELAND | As Jen Overholt brought her children to Dr. Matthew Cory over the years, she grew accustomed to and appreciated features like weekend hours.

His practice, Lakeside Pediatrics, is the medical home for seven Overholt children, from Carter, now 18 and heading off to college in Kentucky, to Piper, less than a year old.

Their mother said she always considered Lakeside to be patient centered, and now the six-doctor practice has official recognition to prove it is.

The National Committee for Quality Assurance recognized Lakeside’s north and south offices this year as patient-centered medical homes.

Watson Clinic’s main, south, Plant City, Bartow and Lakeland Highlands locations also have that recognition, as do Family Physicians Group of Winter Haven and Family Physicians Group of Poinciana, part of a multicounty organization, according to the National Committee for Quality Assurance.

They are among 413 practices in Florida to achieve the designation.

The bottom line is: “What are you doing that meets the needs of the patients in your community?” said Patricia Thorbin, Watson Clinic’s quality-improvement director.

Recognition as being patient-centered shows a medical practice offers multiple patient-focused services and provides documentation to prove those procedures occur consistently.

In a similar vein, The Joint Commission, which accredits health-care organizations, has a program through which they can earn certification as a primary-care medical home.

Central Florida Health Care, a nonprofit community health center with clinics throughout Polk County, is one of eight in Florida and the only one in Polk, to have that accreditation.

Expanded focus on quality primary care, with increased involvement by patients, is a key focus of both health improvement efforts.

MEDICAL HOMES

Advocates consider medical homes a good way to reduce medical costs overall and get better results for patients by having more and better-coordinated care given in primary-care offices. A primary-care medical home is meant to be the hub of a patient’s health care.

Qualifying as a primary care or patient-centered medical home is voluntary, but some expect insurance companies and government ultimately will push medical practices to prove they meet the standards involved.

“A lot of insurance companies want it,” Cory said.

“It’s an opportunity for a practice to know they’re meeting certain criteria.”

How solo practitioners and small medical groups with only limited administrative support can meet the documentation requirements and expanded access needed, however, remains to be seen. There’s skepticism and frustration from some doctors in that position, already struggling to implement government requirements for electronic medical records.

“The individual or two-person practice is really being squeezed out of health care,” said Dr. Sergio Seoane, a Lakeland internal-medicine specialist in solo practice.

Lakeside couldn’t have accomplished it without extra work by Administrator Clark Buurma, Cory said.

With six pediatricians on staff, they have been able to offer weekend and evening hours for years.

That expands access, but Cory said there’s no added reimbursement for evening or weekend work.

The model favors larger groups or people who can afford to hire someone to work on weekends, Seoane said.

When Watson Clinic hired Thorbin a year ago, one of her immediate goals was to work for the recognition.

Most of the components were there, she said, but they needed to be documented.

“They’re looking for you to provide them with a tremendous amount of information that validates all these things, Thorbin said.

BASED ON PRINCIPLES

The program is based on principles adopted by several physician organizations.

They include:

Each patient having an ongoing relationship with a personal physician, who provides all of a patient’s health needs or arranges care with other health professionals.

A doctor-led team taking responsibility for patient care, coordinated across all elements of the health system and the community.

Enhanced access to care through open scheduling, expanded hours and other options for after-hours contact.

Lakeside already met many of the standards, Cory said, but a few changes were needed.

For example, in broaching the subject of a child’s obesity, Cory said, he previously might have written a small amount of information on a brochure about healthy weight and encouraged parents to read it.

Now, there’s a form, and a copy is kept to prove information was provided.

Watson Clinic has beefed up its efforts to encourage patients to use patient portals for safe online access to their doctors and medical records, part of the focus on access and patient self management.

“By putting the patient at the entrance of all we do, the patient-centered medical home model allows patients more personal and active involvement in their own health care,” said Dr. Louis S. Saco, chief executive officer at Watson Clinic.

NEW PROJECTS

New projects are developing as an outgrowth of its evaluation of how the clinic met patient-centered medical home standards, Thorbin said.

In one, employees are starting to contact clinic patients discharged from the hospital to reconcile medicines they already took with ones prescribed at the hospital.

Cory said the national recognition program’s goal — improving care in primary care offices like internists and pediatricians — is essential.

“A lot of primary-care physicians do a pretty good job (of providing a medical home), but not all of them,” he said.

Guidelines used by the Joint Commission and the National Committee for Quality Assurance give a blueprint for what medical homes should be.

Patients can look for these characteristics in their own doctors’ offices, regardless of whether they have recognition or certification.

The Joint Commission calls for patient-centered, relationship-based care; comprehensive care by a health-care team; and coordinated care that includes other health organizations when needed.

It expects groups to provide “superb access to care,” such as broader hours, and systems for quality and safety.

The National Committee for Quality Assurance, in setting its standards for recognition, get guidance from the American Academy of Family Physicians, American College of Physicians, American Academy of Pediatrics and American Osteopathic Association.

The standards include 10 “must-pass” elements, among them systematic tracking of critical referrals, active support of patient self management, and evidence-based guidelines for three chronic or important conditions.

Practices must complete at least five for Level 1 recognition and all 10 for Levels 2 or 3.

Speakers at an Alliance for Health Reform program in May said transformation to true medical homes will be ongoing and the full health outcomes won’t be measurable for years, the family physicians academy reported.

For some practices, Cory said, it will entail “fundamental changes in what they do.”

[ Robin Williams Adams can be reached at robin.adams@theledger.com or 863-802-7558. Read her blog at robinsrx.blogs.theledger.com. Follow her on Twitter @ledgerROBIN. ]

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