Medical Home Guidelines Protect Physician Turf

March 09, 2011

March 9, 2011 — Four primary care medical societies yesterday released guidelines for accrediting patient-centered medical homes that would bar nurse practitioners (NPs) from being in charge of them.

Healthcare reformers inside and outside of government view the medical home — a long-term healing relationship between a patient and a team of primary care clinicians — as a model for delivering care and getting paid for it, too. For a practice to qualify for third-party payments as a medical home, an organization has to designate it as such. Therefore, physicians have a lot at stake in the criteria that these groups use to distinguish medical homes from ordinary practices.

Accordingly, the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Osteopathic Association released a joint set of guidelines for programs that accredit or otherwise recognize medical homes. The societies stated that they want to ensure that these programs are standardized and stay focused on core principles, which include comprehensive, coordinated, and continuous care; accessibility; and patient engagement.

"All of This Is Basic Nursing"

Groups that currently accredit or recognize practices as medical homes are the National Committee for Quality Assurance, the Accreditation Association for Ambulatory Health Care, and URAC, formerly known as the Utilization Review Accreditation Commission. A fourth group, the Joint Commission, plans to unveil such a program later this year.

The new guidelines urge these groups to incorporate a set of medical home principles adopted by the 4 primary care societies in 2007. One of these principles, that physicians should lead the medical home team of clinicians, is a point of controversy within healthcare because NPs also aspire to direct such teams.

The Accreditation Association for Ambulatory Health Care agrees with the primary care medical societies. It specifies that an accredited medical home is physician-directed. In contrast, the National Committee for Quality Assurance announced last fall that it would recognize nurse-led practices as medical homes in states that license NPs as independent practitioners. By defining medical homes as "clinician-led," URAC also leaves the door open to nurses being in charge, said NP Jan Towers, PhD, director of health policy for the American Academy of Nurse Practitioners.

Dr. Towers told Medscape Medical News that the concept of the patient-centered medical home and its emphasis on continuous, coordinated, and comprehensive care describe what nurses do routinely. "All of this is basic nursing," Dr. Towers said.

When asked about the insistence by organized medicine that physicians head medical homes, Dr. Towers answered, "They still think the rest of the world is wrong, and they're right."

American Academy of Family Physicians President Roland Goertz, MD, countered in an email to Medscape Medical News that primary care physicians "are uniquely trained, comprehensively oriented, and prepared best to be the leader and coordinator of the patient-centered medical home."

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