The PCHQ Model may be beneficial within our society given the new reform bill will increase the demand for primary care physicians when there is already a low supply. The model would increase the number of jobs available in the health sector for all levels of care (assistant to physician). Including midlevel providers such as NPs and PAs would be beneficial and would take care of individuals that need prescriptions, a physical or screening.
Previously working in an Orthopaedic clinic, I was able to see how incorporating different health care workers can be beneficial in order for the physician to save time and increase the number of patients in the clinic, but it almost felt like working in a factory line. Additionally, the physician can become more “choosy” on which patients they want to see or not. If the PCHQ model is to be implemented, it needs to be determined who makes the decision on the provider the patient sees, as in the clinic this was done by the secretaries and schedulers. This created problems when the patient was assigned to see the wrong provider.
I believe that most patients would much rather be seen by a physician as opposed to their assistant. Transferring over too many responsibilities to other providers has the potential for more mistakes, like misdiagnosis, or a patients problem may be neglected, and this can decrease the quality of care. Increasing the amount of individuals that the patient must see only increases the time that they have to spend at the doctors office and has the patient potentially go through a series of individuals before their condition is fully addressed. This makes it less appealing to go to the doctor.
My PCP is one that does not have a medical assistant, secretary, biller or nurse. She has utilized a efficient electronic system which helps to take on some of these responsibilities and reduces cost. She may not be seeing as many patients, but I get the highly individualized care where I am not restricted to only a 15 minute visit and the provider is reimbursed without many deductions. Even though this form of care may not fully meet the high demand, it would significantly reduce cost, cost being something that would be high in the Medical Home model.
Very interesting article. Our Peds clinic was recently recognized as a PCMH. The concept is great, the execution is very difficult. In fact, our clinic used to act more as a PCMH in the past. However, reimbursement rules changed that as currently practices are paid to see patients, not manage their care. What I mean is that if I place a referral for Patient X, I am too busy seeing Patient Y to find out if Patient X received an appointment from the specialist. Patient X is left hanging out in the system somewhere. If all works well, Patient X gets his specialty appointment. If there is a kink in the system, no one but Patient X knows it until he comes back for his next appointment.
While being a recognized PCMH does come with different incentives, the transition before reimbursement is difficult. To have a true PCMH requires an increase in staffing and a shifting of priorities.
The Team concept is also not without difficulty. Failure of communication is a known cause of medical errors. As practices change to a PCMH model, efforts to ensure good information flows will be necessary as well.
The PCHQ Model may be beneficial within our society given the new reform bill will increase the demand for primary care physicians when there is already a low supply. The model would increase the number of jobs available in the health sector for all levels of care (assistant to physician). Including midlevel providers such as NPs and PAs would be beneficial and would take care of individuals that need prescriptions, a physical or screening.
ReplyDeletePreviously working in an Orthopaedic clinic, I was able to see how incorporating different health care workers can be beneficial in order for the physician to save time and increase the number of patients in the clinic, but it almost felt like working in a factory line. Additionally, the physician can become more “choosy” on which patients they want to see or not. If the PCHQ model is to be implemented, it needs to be determined who makes the decision on the provider the patient sees, as in the clinic this was done by the secretaries and schedulers. This created problems when the patient was assigned to see the wrong provider.
I believe that most patients would much rather be seen by a physician as opposed to their assistant. Transferring over too many responsibilities to other providers has the potential for more mistakes, like misdiagnosis, or a patients problem may be neglected, and this can decrease the quality of care. Increasing the amount of individuals that the patient must see only increases the time that they have to spend at the doctors office and has the patient potentially go through a series of individuals before their condition is fully addressed. This makes it less appealing to go to the doctor.
My PCP is one that does not have a medical assistant, secretary, biller or nurse. She has utilized a efficient electronic system which helps to take on some of these responsibilities and reduces cost. She may not be seeing as many patients, but I get the highly individualized care where I am not restricted to only a 15 minute visit and the provider is reimbursed without many deductions. Even though this form of care may not fully meet the high demand, it would significantly reduce cost, cost being something that would be high in the Medical Home model.
Very interesting article. Our Peds clinic was recently recognized as a PCMH. The concept is great, the execution is very difficult. In fact, our clinic used to act more as a PCMH in the past. However, reimbursement rules changed that as currently practices are paid to see patients, not manage their care. What I mean is that if I place a referral for Patient X, I am too busy seeing Patient Y to find out if Patient X received an appointment from the specialist. Patient X is left hanging out in the system somewhere. If all works well, Patient X gets his specialty appointment. If there is a kink in the system, no one but Patient X knows it until he comes back for his next appointment.
ReplyDeleteWhile being a recognized PCMH does come with different incentives, the transition before reimbursement is difficult. To have a true PCMH requires an increase in staffing and a shifting of priorities.
The Team concept is also not without difficulty. Failure of communication is a known cause of medical errors. As practices change to a PCMH model, efforts to ensure good information flows will be necessary as well.