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Primary doctors transform offices into patient-centered 'medical homes'

A few Hampton Roads doctors' offices are transforming themselves into patient-centered medical homes.

And that means more than just replacing outdated waiting-room magazines.

The concept of establishing "medical homes" emerged in the health-care reform debate as a way to improve health-care quality and efficiency and cut costs. The patient-centered medical home tends to the health of the whole person, involving a team that's responsible for the patient's care. That includes coordinated, integrated care among primary care, specialists and hospitals.

Built on a doctor-patient relationship, it re-establishes the primary care provider as the backbone of the health-care system.

"It would save billions of dollars of wasted money," said Dr. Peter Anderson of Riverside's Hilton Family Practice in Newport News. "You can't have the best care and the most cost-effective care without having a physician who knows you."

A doctor who knows a patient well can order far fewer tests to diagnose a complaint than a doctor who's unfamiliar with the patient. And there should be fewer duplicate tests ordered by primary care offices, specialists and emergency departments.

"There should be less repetition. There should be less use of tests that aren't necessary, less ER use, less hospital use," said Dr. Christine Matson, Eastern Virginia Medical School's chair of family and community medicine. "Reducing the cost is a big part."

EVMS physicians and faculty are transforming their practices and will soon apply for recognition by the National Committee for Quality Assurance as a patient-centered medical home.

Anderson's practice has already achieved that status, along with Sentara Virginia Beach Family Practice in Virginia Beach. Several more Sentara practices are in the application process, adding up to 32 total physicians overseeing 64,000 patients. Bon Secours Hampton Roads is working with practices in Isle of Wight and Virginia Beach to transform them into patient-centered medical homes.

Patient-centered medical homes provide more access than a typical doctor's office. Anderson can often see his patients the day they call. That's largely unheard of in the industry, causing problems to worsen or leading to costly emergency-room visits, he said.

The concept is catching on, he said. Chances are, the changes will come to your physician's office.

"Insurance companies are going to start paying doctors' offices more if they're a member of PCMH," Anderson said.

"I don't think it's a fad. I don't think in two years, you're going to be hearing about another model of care," he said. "The question is, Can we attain this model? It's a very good model of care that patients need and deserve and offices have been unable to deliver."

Becoming a patient-centered medical home is asking doctors to do more when they're already busy just keeping up with status quo. That's why it takes changes in the way physicians' offices are structured, Anderson said.

"We don't need more money in primary care. But we do need to practice much more efficiencly than we already are," he said.

He beefed up his staff, adding nurses whom he trained to take medical histories and work with electronic health records. That enables him to see 35 patients a day, when other practices see 20 to 22 patients.

As a result, "I saw my quality reach levels I could never touch before," he said.

Anderson was hired by the Army as a consultant in a pilot program converting 21 clinics into patient-centered medical homes. One month after the first clinic made the change, the results were so positive the Army is considering expanding the program, Anderson said.

The focus on patient-centered medical homes would not be possible if not for electronic health records. Electronic records make it easy to see a doctor's track record. For example, Anderson ranked in the 90th percentile for hypertension, colorectal, mammography and diabetes care in a National Committee for Quality Assurance study, while his patient satisfaction ranked in the 95th percentile.

Electronic records also make it easier for doctors to keep track of patients. Doctors' offices can be notified if patients have been admitted or discharged from a hospital or have missed a timely screening.

"We're not just treating the patient as they walk in the door," said Dr. Bruce Britton, an EVMS associate professor family medicine. "We're thinking about the patient when they're not in the office."

Sentara's patient-centered medical home practices have a policy that patients discharged from the hospital will be called within days to schedule an office visit. Studies have shown that prompt follow-up after discharge reduces hospital readmissions, said Dr. Shane Peng, vice president and senior medical director of Sentara Medical Group. Coordinating that follow-up appointment takes a team approach.

"We do have to rethink how the doctor's office operates," Peng said. "Currently physicians in medical practices are really, really busy. They're really working as hard as they can, trying to do a great job. What we are offering through our pilot is helping the doctor see the right patient at the right time and giving the physician and the care team the resources they need to get the job done."

Michael Williams of Hampton has been a patient of Anderson's for 10 years or more. Unlike other practices, he doesn't wait for hours in the waiting room, he said. And a few times, when something has come up, they fit him in for an appointment the day he called.

"I've never had an occasion that something popped up and they didn't make room for me," he said. "He's excellent. I didn't have any type of problem that he didn't jump on it, giving me the care that I think I deserve. It's just the way he handles me as a patient — helpful, concerned, those things that really count when your health is at stake. I really feel like he's looking out for my best interests."

Copyright © 2014, The Baltimore Sun
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