A key reason why physicians are not jumping on board with the PCMH model is that they aren't certain how it affects their bottom line.
More than one-third (37.9%) are still unsure about the structure and purpose of medical homes, according to a report released by The Physician’s Foundation that includes responses from more than 13,000 physicians. Almost the same amount (37.7%) believes the model is unlikely to improve quality and reduce medical costs.
A recent study published in The Journal of the American Medical Association seems to support physician perspective on lack of quality improvement.
Marci Nielsen, chief executive officer of the Patient-Centered Primary Care Collaborative, isn’t surprised by the report, or the JAMA article, or the media attention.
“When you see that kind of media attention, you need to look a little bit deeper,” Nielsen says. “I think what you’ll see is [people believe] this model is a threat to the status quo.”
Consider the source
Nielsen explains that within a single week there were 28 different stories, both pro and con, related to the JAMA article. The good news is that people care, and want to know whether the patient-centered medical home (PCMH) works. The less-than-good news is the media hype around the story.
“Were that study to have said ‘guess what, we found phenomenal results in southeastern Pennsylvania,’ the study would not have garnered nearly the media attention,” Nielsen says. “So, something is up here, and a conspiracy theorist might say that there are enough folks whose world will be turned upside down should we move to a model that really incentivizes primary care in significant ways.”
She’s also not surprised by physician perception. She points to a sense of fatigue around payment gimmicks that have frustrated and exhausted doctors; payment systems that were supposed to solve healthcare’s problems the last go-around, but didn’t.
“Physicians and other healthcare professionals say [PCMH] is just the flavor of the day,” Nielsen explains.
What’s not to like?
Nielsen believes a key reason why physicians are not jumping on board with the PCMH model is that they aren’t certain how it affects their bottom line. While primary care physician groups recognize it as a model that invests in primary care and believe it’s long overdue, others are not so sure.
“I was having dinner with a group of physicians, and a surgeon pulled me aside and asked, ‘Seriously, how does this impact me?’” Nielsen recalls. “I think his question, and it’s a very practical and human one, is ‘yeah, I am theoretically interested in this model, but I don’t know how it will impact my bottom line. I’m 55 years old, and I’m going to be practicing medicine for at least another 10 years … is this going to upset the apple cart?’”
But Nielsen believes that as physicians—both primary care and specialists—figure out how to maximize the PCMH model, they’re going to get pretty excited about its potential.
“The bottom line is, if we are advancing a true patient-centered medical home; if we’re implementing true transformation of the health system by investing in primary care; improving the care coordination for patients who are chronically ill; improving access for patients who don’t use the system much but when they do they want it to be convenient; and improving overall quality and safety,” she says. “Who can’t like that model?”
However, she admits that while the validity of the model is appealing, the question of how to get there is what makes clinicians tired.
Nielsen says that for the PCMH model to be successful, it requires physician leadership and engagement. She points to studies conducted on the process involved in becoming a PCMH, and says that leadership and culture change rise to the top every time.
“This isn’t something that can be done by your office manager or a motivated staff person,” she says. “It is an entire philosophy that starts with the clinicians and physicians themselves.”
The second most important element to the success of the PCMH model is the buy-in by multiple payers. For example, if a physician is located in a state where Medicare is the only payer for a medical home, or the only buyer of medical care willing to offer an increased reimbursement, the chances physicians will embrace this model are slim.
And then there’s the patient aspect. Nielsen says patients love this model, and expect this model of care when they are brought into the process in a very real way.
“Physicians need to use the patient and their family as part of the change process, and learn all kinds of good things about what they could do in their practice to make it more patient centered,” she says. “For the small number of docs who do it, they often find the most valuable and unexpected benefit to their practice is the terrific ideas and engagement they get from patients who are their customers.”