Introduction to the Interview With Roland Goertz, MD
The American Academy of Family Physicians (AAFP) released its report, "Primary Care for the 21st Century," in September 2012. It generated considerable controversy among the nursing community because of its emphasis on a patient-centered medical home (PCMH) run by a physician rather than other primary care clinicians, notably nurse practitioners (NPs). What was generally overlooked in the middle of this debate was the report's discussion of the evidence on the increasing successes of many PCMHs in improving outcomes in health, care, and costs. Medscape interviewed Roland A. Goertz, MD, MBA, Board Chair of the AAFP, about the findings in the report and the issues that it raised among other professionals in the health community.
The Medical Home: Successful and Scalable
Medscape: The AAFP report was very positive about the increasing successes of the PCMH. According to a recent report from the Patient-Centered Primary Care Collaborative (PCPCC), 21 PCMH models have achieved outcomes of better health, better care, and lower costs. Could you go into any detail or make any generalizations about how such outcomes were accomplished and how the best models can be scaled?
Dr. Goertz: A number of resources are available that provide information on the PCMH, including the AAFP's Website and on the Websites of the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association. The Website of the PCPCC also has good information. In addition, there are now 4 entities that will actually give certification on certain levels of PCMH criteria: the National Committee for Quality Assurance, The Joint Commission (formerly the Joint Center for the Accreditation of Healthcare Organizations), the Accreditation Association for Ambulatory Health Care, and URAC.
The PCPCC follows outcome studies on the medical home model, and its recent report provided summaries of 34 sites across the country from the West to East Coast, from small practices to large group practices. For medical homes that have been put into practice, the report showed reductions in hospital admissions that ranged from 6% to 53% and in emergency department visits from 10% to 70%.
In order to determine where cost savings typically come from within the medical home models, you cannot look only within the ambulatory or clinical area. The model seeks to achieve savings across all lines of costs, whether it's hospital outpatient or inpatient costs. Very frequently more needs to be invested in the PCMH site itself. The 2 studies that are summarized in the report show that the predominance of the cost is decreased in emergency department usage and admissions to hospitals for health issues that can be dealt with in a different way.
Medscape: Is the medical home more successful in certain regions or communities; for example, rural vs nonrural?
Dr. Goertz: The model was created with much input from patients about what they desire from their personal physician and care site. We believe that it works in many areas. In some areas it may have a larger impact on cost savings than in other areas; but no matter where it's implemented, availability and access will increase, quality will improve, and costs will be lowered because the model requires us to measure and look at ourselves and then to assess how to improve things.
Medscape: Do you find that these models can be scalable?
Dr. Goertz: Yes, and they are not just scalable in size but to different health delivery systems and across different payer groups. The PCPCC has results from commercial payers to Medicare and Medicaid environments.
Medscape: How long would it take for a practice to implement the medical home model?
Dr. Goertz: This is a very important question. How long would it take a practice or a physician's team to go through this transition? The total effort is a combination not only of putting all the modern tools in place but also putting in place evaluations of workflow. Many of those things take time, with reiterations of looking at how to improve service for patients, but, from the studies so far, we know that a practice can make good progress in 2 years or less. I should mention that many practices have already been using elements of the PCMH for years, so the transition can be much faster depending on how far along such practices are and what elements and tools they may already have in place.
Medscape Internal Medicine © 2012 WebMD, LLC
Cite this: Running a Medical Home: It Works, but Who Leads? - Medscape - Oct 09, 2012.