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The Medical Home Gains Momentum: Could a team-based model work for otolaryngology?

by Geri Aston •

PCMH criteria can be expensive and difficult to meet, an evaluation of the two-year AAFP pilot project showed. “Transforming from a physician-centric practice to a team-based, patient-centered model is challenging for physicians who are accustomed to being responsible for the entire patient encounter,” the evaluation team noted. “Developing care teams requires substantial cross-training efforts, as well as developing a shared vision among front- and back-office staff of how care teams affect the patient experience. Most practices will need additional financial and human resources to achieve full medical home transformation.”

Any non-primary care specialty practice that wants to meet the criteria could become a medical home, Dr. Goertz said, but he suspects that most would not want to, because providing primary care isn’t their goal. Dr. Weissler agreed. “I don’t think it’s realistic that otolaryngologists are going to want to manage conditions like diabetes or chronic obstructive pulmonary disease.”

It’s more likely that specialists would opt to work with primary care PCMHs to coordinate care, Dr. Goertz said. The AAP spokesperson said that good relationships with pediatric subspecialists are essential for the success of pediatric medical homes.

Medical homes, if structured properly, could strengthen communication and care coordination between specialists and primary care doctors, said Dr. Weissler. “That’s the dream, but right now it’s sort of just a dream.”

Joint Principles for Patient-Centered Medical Homes

  • Personal physician: Each patient has an ongoing relationship with a personal physician who provides first contact, continuous and comprehensive care.
  • Physician-directed medical practice: The personal physician leads a team of individuals at the practice level who collectively take responsibility for patients’ ongoing care.
  • Whole person orientation: The personal physician is responsible for providing for all of the patient’s health care needs or appropriately arranging care with other qualified professionals.
  • Care is coordinated and/or integrated: This occurs across all elements of the health care system and the community. Care is facilitated by registries, information technology, health information exchange and other means.
  • Quality and safety: Physicians use evidence-based medicine and clinical decision-support tools to guide decision making and engage in performance measurement/improvement.
  • Enhanced access to care: This is available through such systems as open scheduling and expanded hours.
  • Payment: The payment structure recognizes the added value provided to patients who have a patient-centered medical home.

Source: pcpcc.net/joint-principles