Any practice can become a medical home, but transition not easy
■ Adopting the model requires a practice redesign and much more than incremental changes.
By Susan J. Landers — Posted May 25, 2009
Transforming a traditional primary care practice into a patient-centered medical home is possible, but the change takes time and patience, according to a report in the May/June Annals of Family Medicine.
"It's a marathon, not a sprint," said Paul Nutting, MD, MSPH, the study's lead author and director of research for the Center for Research Strategies, a Denver consulting firm.
Dr. Nutting and other researchers examined a two-year demonstration project of the medical home concept developed by TransforMED, a wholly-owned subsidiary of the American Academy of Family Physicians. It was established in 2008 to provide consultation and support to physicians looking to transform their practices to medical homes. The project, which featured 36 family practices, ended last year.
In their report, researchers highlighted lessons learned by the practices. Among them:
- The process requires whole-practice reimagination and redesign. It is much more than incremental changes.
- Information technology is underdeveloped for small practices and difficult to implement.
- The process takes more than the two years allocated to the AAFP project and requires first building a strong core that is capable of managing basic finances and clinical and practice operations during times of modest change before embarking on more complex changes.
- There are multiple pathways to becoming a patient-centered medical home, each dependent on conditions within the practice and the community.
The medical home model has attracted much attention as a possible centerpiece for health system reform now under discussion in Washington. The model is intended to guide primary care physicians in developing more cost-effective, efficient practices that deliver the best care to patients. Physician groups are working on principles to shape that model and ensure proper funding and payment structures.
"The data show us it's possible for a wide variety of practices, large and small, urban and rural, to implement the model components," Dr. Nutting said.
Physicians who took part in the project said they have more work to do to transition to the medical home concept.
"It's not an easy process, and there are a lot of ups and downs," said family physician Theresa Shupe, MD, who practices with one other physician in Haymarket, Va., about 40 miles from Washington, D.C.
During the project, she had some surprises. For example, not all patients were thrilled at being able to access their medical records and read lab results on a secure Web site. There were software glitches, and some patients and staff required a great deal of training.
"It is saving us a lot of time in the long run, but it wasn't as easy to implement as I thought it would be," she said.
On the other hand, Dr. Shupe said, patients, physicians and staff are delighted with the open-access scheduling the practice adopted. No appointments are booked more than two weeks ahead, even physicals. Most patients are seen the same day they call the office.
"When I come in the morning I might have three or four appointments scheduled, but by the end of the day, I've had a full schedule," she said.
The study validates a lot of what is going on in the national discussion on health system reform, said Terry McGeeney, MD, president and CEO of TransforMED.
"It shows that small- and medium-sized practices can make the changes that everybody is saying primary care physicians need to make. It's not just large practices."