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Medical home model beginning in Connecticut

Open-access scheduling is significantly reducing wait times for appointments at primary care physician offices, a report says.

By Carolyne Krupa — Posted Dec. 7, 2010

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Many Connecticut physicians are beginning to integrate elements of the patient-centered medical home model into their practices with some positive results, according to a new report.

In a survey of 498 primary care physicians in the state, the Connecticut State Medical Society found that 57% of doctors were using open- or advanced-access scheduling, 39% had electronic medical record systems and 33% had registries of patients with chronic diseases.

Open-access scheduling significantly cut patient wait times for appointments from an average of 15.3 days to 9.9 days, according to the report.

But widespread implementation of the medical home is hindered by a variety of factors, including the small size of most Connecticut medical practices, said the report published in the November-December issue of the journal Connecticut Medicine.

"The majority of physicians in our state are in small or solo practices, and the kind of coordinated care that is the hallmark of the medical home approach can require more administrative support than these practices can provide," said CSMS President David S. Katz, MD.

Seventy-five percent of the state's family physicians practice in groups with fewer than five doctors. Elements of the medical home, such as having an EMR system and hiring additional health care professionals to coordinate care, "come with costs that are very difficult for a small practice or small business to bear," said report co-author Audrey Honig Geragosian, a spokeswoman for the medical society.

Installation of medical records alone can cost about $20,000, she said. "That's a big chunk of change to lay out, and our small practices may not have access to that kind of capital at this point."

Use of elements of the medical home model varied by specialty. For example, open-access scheduling was least common among internists, while pediatricians had the lowest use of EMRs, according to the report (link). Adoption of medical homes is still in its infancy in Connecticut, the report said.

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