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‘Medical home’ concept takes focus off profit-making, putting patient needs first

‘Medical home’ concept takes focus off profit-making, putting patient needs first

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Julie Burke is a busy mother of three boys who has better things to do than sit in a doctor’s office waiting for an appointment.

That’s why the Sparta woman has been happy to participate in a two-year pilot program at the Sparta Clinic of Mayo Health System-Franciscan Healthcare exploring the escalating trend toward a practice called patient-centered medical home.

The concept, which adds PCMH to the large lexicon of medical acronyms, aims to involve patients more in their care, according to officials at Mayo-Franciscan and the Gundersen Health System.

Burke’s involvement included lobbying for streamlining office visits at the Sparta Clinic, which she said has occurred.

“The time sitting in the waiting room has been drastically reduced,” said Burke, 44, an apparel manager at McPherson Companies in Sparta, the business involved in the pilot.

“When I can spend more time with the doctor and less time in the waiting room, it improves all of our lives,” she said.

With boys ages 6, 9 and 12, “I’m in there a lot,” she said. “From a simple ear infection to an illness, pink eye, swimmers ear. It’s constant. They’re boys, so it’s going to be that way.”

Timing also was of the essence for 66-year-old Al Sommers of Lewiston, Minn., who had a precancerous mole he wanted removed this week.

Told that the earliest appointment from one provider was Jan. 29, he opted instead for a quick appointment with Lisa Nutter, a family nurse practitioner at Gundersen’s La Crescent clinic.

Sommers, who had gone to Nutter when she practiced in a Lewiston clinic before it closed, said he continues to see her at the Gundersen clinic for routine exams, injuries or illnesses.

“I ask for her and get scheduled right away,” he said.

When Sommers needs specialized care, he goes to a specialist at Gundersen Health System in La Crosse.

Sommers said he also appreciates the fact that he and all of his providers have access to his records via computer.

Such is the emerging world of PCMH, which Consumer Reports characterizes as “a doctor’s office that’s all about you,” with facets including extended hours for greater patient convenience.

Gundersen Health System, where the model has been emerging since 2009, recently received PCMH certification from the National Committee for Quality Assurance for more than 30 of its sites in the 19 counties it serves in Wisconsin, Minnesota and Iowa.

“It’s meeting the patients where they are,” said Dr. Marilu Bintz, a medical vice president at Gundersen. “In the old model, a doctor would sit down and say, ‘Look at these numbers. You’ve got to stop smoking and lose weight and lower your cholesterol.’”

Instead, medical home “is about getting to know the patient,” including family, financial and other factors that may affect health, Bintz said.

“We’re trying to establish a home for the patient that’s not just for acute care … but goes beyond that,” she said.

“Some very complex hospital situations can be avoided if you pay attention to the patient,” she said.

“One of the ripple effects of patient-centered medical home is understanding what patients want, what patients need, and to engage them in those discussions. ‘Do I need that procedure? What if I don’t get it?’” she said.

Involving patients improves outcomes because the care takes their own goals into account, she said.

It also invites better care coordination from a team that may include a physician leader, along with a nurse practitioner, a medical assistant, a registered nurse, a social worker and a mental health professional, she said.

“Integrated care was not always easy to offer in traditional settings. Better coordination prevents redundancy in testing,” she said.

“Ultimately, another spin-off is the ability to increase access to doctors. By not relying on the physician to do everything from soup to nuts, it frees up access to doctors,” Bintz said.

The Sparta clinic is one of several Mayo sites involved in Mayo’s pilot. Information gleaned from them is creating what that health system calls the Mayo Model of Community Care rather than PCMH, said Dr. Marc Tumerman, physician lead for the Sparta pilot.

“What we learned from a practical standpoint is what it takes to provide care that focuses on patient needs,” Tumerman said. “We learned how to do team-based care involving nurses and doctors.”

A patient’s needs often can be met by seeing a nurse practitioner or nurse rather than a doctor, he said.

“No matter how good a doctor is, we also have to rely on the skills of nurses, pharmacists and others. The more we empower the team to do, the better,” he said.

“If it makes more sense in a diabetic case to have the patient make a monthly call to a nurse instead of seeing a doctor every three months, we should do that,” he said.

As at Gundersen, listening to patients is a key element, he said, adding, “In my practice of 30 years, this was the first time it’s involved patients to improve care.”

Patient Julie Burke found that aspect appealing, saying, “They needed the correct information to move forward.”

As the pilot project moves toward its conclusion in March, clinic personnel “seem friendlier, more confident and more professional,” she said.

Terry Lee, human resources manager at the 385-employee McPherson Companies, said, “We look at it as being a solution to part of a bigger problem — health care delivery.

“We believe this type of health care will take time, but we’re glad to be a part of it,” Lee said.

The time will be well spent with the practice’s potential to reduce health care costs, Tumerman and Bintz said.

“In the old system, the more patients you saw and the more procedures you did, the more money the institution made,” Tumerman said. “That was a perverse system.”

In the quest for better care, he said, “The things we’re doing may not always be in the financial interests of the institution.”

It also will require persuading insurance companies to cover things such as lower-cost visits with nurses versus seeing a doctor, Tumerman said.

“In the patient-centered medical home model, there is much more emphasis on getting people healthy and keeping them healthy,” Bintz said. “If we can keep people from obesity, that will lower costs.

“The stronger emphasis on preventive care can significantly impact the cost of medical care,” she said.

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