Transitioning to the PCMH Model

The concept of the patient-centered medical home (PCMH) has received its share of attention as the cure for what ails the American health care system. But how does a medical practice ensure a successful transition to the PCMH model? And how does a practice know it’s the right time to make that transition?

Christine Leyden, RN, MSN, senior vice president and chief accreditation officer for URAC, says there really is no wrong time when it comes to transitioning to the PCMH model. That’s because the principles of the model, promoting patient engagement and patient safety, should be the first step in designing any practice.

“Most practices today have those key components,” Leyden says. “The key is do they have the infrastructure in place to integrate the components of an electronic health record?”

Infrastructure components

Don Darst, MD, is an internal medicine specialist and founder of Midwest Regional Health Services clinic at The Nebraska Medical Center. Two years ago, he determined that in order for the clinic to be properly positioned for health care reform, transitioning to the PCMH model made sense — especially since the clinic already had an electronic medical record system in place.

“If you want to apply for pay-for-performance, you have to be able to report on the population of patients you have — how many have mammograms, how many have colonoscopies, those kinds of things, and that is not routinely measured in the primary care practice,” Darst explains.

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ut when he suggested running those reports, his physicians thought it was a waste of time.

“They said, ‘We already have high compliance with our cholesterol patients, and our breast cancer surveillance is wonderful,’” Darst recalls. “So we ran the reports and found that the frequency of what they thought was real high quality care was actually appallingly low.”

Little arm-twisting was required after that. According to Darst, seeing actual data on their performances was an “eye-opener” for the physicians. Darst was able to get them on board because they realized they needed to make a change.

Meaningful data

Leyden says that a key component of the PCMH model is that patients are engaged and taking responsibility for their care. They’re active members of the health care team. For that to happen, it’s important to provide them with data that is meaningful and easily understood. Leyden suggests that physicians provide patients with a print out summary of their treatment visits.

“So when they leave the physician’s office, [the summary] says the doctor went over my meds with me, or the nurse went over my meds with me, and I now know they changed my dose,” Leyden says.

Meaningful data is important for physicians as well. Darst recalls passing out sealed envelopes containing each physician’s quality readings at a monthly meeting. Each physician opened his or her own report, and then slowly began to lean back in their chair to sneak a look at the person on either side to see where they sized up.

“I noticed that was going on, so we turned it into a healthy competition,” he says. “And oh my God, the numbers just went up like crazy. We had to be accountable. And where we weren’t performing well, we had to be man enough to say we’re not doing a good enough job here.”

Seeing the results

Operating within the PCMH model enabled Darst’s clinic to take a more proactive approach to patients’ health care. Data revealed that clinic physicians had low compliance with regard to foot exams for diabetics. A diabetes day was scheduled, and approximately 40 diabetic patients who hadn’t had a foot exam were contacted and scheduled for a group appointment.

“It was like speed dating,” Darst recalls. “Every 12 minutes we’d hit the bell, and the patient would move from the reception area where they watched an educational video of me talking about diabetes to the dietician. At the next bell they went to see the podiatrist, and the next bell they got their eyes dilated for their eye exam, and the next bell they got their blood taken for their hemoglobin A1C and their cholesterol, and the next bell was the doctor who ties this all together and prepares a plan for what we would do about their diabetes in the coming year — all specific to them. We got everyone caught up and everybody had their own specific plan for their specific care.”

Darst also explains that transitioning to the PCMH model made meeting meaningful use qualification incredibly easy.

“All we had to do was tweak a little here and make minor adjustments, and we had all our physicians qualify for meaningful use,” he says. “That was a nice shot in the arm.”

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