PCMH – Why It Shouldn’t Be “Just One More Thing To Do”

LisaGouinBy Lisa Gouin, PCMH Services Manager, eHealthcare Consulting, Inc.
Twitter: @ehealthcareorg

“As if EHR implementation, Meaningful Use and PQRS aren’t enough, now you want me to do Patient Centered Medical Home and a complete practice transformation…just one more thing to do, PCMH!” This phrase, uttered by many providers, managers, administrators and staff, was most likely your response as well. Years ago I was a frustrated member of this group as the practice that employed me decided to work toward PCMH recognition. Although I had serious reservations about its purpose, I eventually became very passionate about the concepts and goals driving it, and came to the conclusion that this is exactly how healthcare should operate.

The concepts behind PCMH align with the Triple AIM of improved experience for the patient, improved health of populations, and lowered healthcare costs. This goal is achieved through patient ease of access to care, team-based care, population health management, care coordination, care management and performance/quality measurements. PCMH is about treating the whole person, involving the patient in self-management, and encouraging them to play a major role in controlling their own health and outcomes.

Example of PCMH versus non-PCMH patient experience:
Mrs. Smith had not been feeling well for a few days and was concerned about possible pneumonia. It was a Monday, and she had assumed that she would be unable to get in to see her primary care provider that same day, so she headed directly to the Emergency Room. She spent approximately five hours in the ER, had laboratory testing done, as well as a chest x-ray. The physician informed her there was no evidence of pneumonia present, thus she was instructed to go home and get lots of rest. She also was instructed to follow up with her primary care physician in 2-3 days.

Scenario 1 (Non-PCMH patient experience):
On Wednesday, Mrs. Smith visited her doctor’s office. She explained to the nurse that she had gotten concerned about pneumonia and made a trip to the ER. Upon later repeating the story of her ER visit to her primary care physician, she admitted she was feeling significantly better. The physician asked Mrs. Smith if any testing had been done while she was in the emergency room, and if so, if she knew the status of those results. Mrs. Smith stated they had taken a chest x-ray and done some lab work, but she was uncertain of exactly what type of lab work they performed. The provider concluded the appointment by stating that since she was feeling better there would be no need for further appointments, but to contact their office should any unforeseen issues arise.

Scenario 2 (PCMH patient experience):
On Wednesday, Mrs. Smith visited her doctor’s office. The nurse stated that upon reviewing her chart she noted Mrs. Smith had visited the ER on Monday, and asked if she was feeling better. The nurse explained the doctor had reviewed all the test results from her ER visit, and would be in soon to discuss them with her.

Mrs. Smith’s physician later entered and stated, “I see you were in the Emergency Room on Monday. I reviewed your lab and radiology results, and saw there was no pneumonia present, so hopefully you are feeling better. I did notice when I reviewed your labs that your glucose was slightly elevated. Do you have any family history of diabetes? I also see that you haven’t had a health maintenance exam in over a year so we’ll need to schedule that and have your glucose checked again in two weeks. Additionally, a pneumonia vaccination is strongly recommended for your age group, so if you are fine with having that done we will include that in the same visit. I do wish to mention that for the convenience of our patients we offer same-day scheduling, so please always contact us prior to going the emergency room. Hopefully we can work you in and avoid a costly trip to the ER. Do you have any further questions for me, Mrs. Smith?”

Which scenario would you prefer for yourself? Your children? Your aging parents?

I can assume most all would choose scenario 2. Improving the patient experience, improving the quality of care, involving the patient in their own healthcare, better outcomes, better chronic disease management, increased preventative care, lower costs, information exchange among providers and facilities and case management……..these are the goals behind Patient Centered Medical Home, and why PCMH shouldn’t be considered “just one more thing to do”.

About the Author: With over 20 years of involvement in the healthcare industry, Lisa brings 15 years of practice management and practice transformation experience including responsibility for the overall success of Meaningful Use, PQRS and PCMH standards and goals. Lisa is a Certified Chronic Care Professional and pursuing the NCQA PCMH Certified Content Expert certification.