Comments on: Saving Primary Care: Is There Anyone Home?

By: The Doctor & The Orthodontist » GlassHospital

The Doctor & The Orthodontist » GlassHospital — Sun, 23 Oct 2011 09:09:09 +0000

[...] written before about the concept of “Patient-Centered Medical Homes,” [PCMH] a high-minded concept in [...]

By: Health Care Privacy Primer » GlassHospital

Health Care Privacy Primer » GlassHospital — Sun, 18 Sep 2011 16:01:14 +0000

[...] what it was drafted for? After all, it took the passage of Obama’s health care reform bill (PPACA) to ensure that people won’t lose health insurance despite changes in job status. Is HIPAA [...]

By: Around the Mediverse: August 18, 2010 « The Notwithstanding Blog

Around the Mediverse: August 18, 2010 « The Notwithstanding Blog — Thu, 19 Aug 2010 03:55:22 +0000

[...] be determined by patient desires. That is, if the PCMH model is workable to begin with… an arguable proposition. Of course, if recent trends with retail clinics are any indicator… well, it could indicate [...]

By: Rethinking the medical home | HealthBeat

Rethinking the medical home | HealthBeat — Mon, 16 Aug 2010 15:28:41 +0000

[...] I’m not the only one; Dr. John Schumann, who blogs at GlassHospital, recently came right out and declared, “It’s never going to [...]

By: Grand Rounds – July 27, 2010 (Vol. 6, No. 44) | InsideSurgery Medical Information Blog

Tue, 27 Jul 2010 02:42:38 +0000

[...] the terrifically named blog Glass Hospital, there is an argument that the current concept of the Patient-Centered Medical Home won’t [...]

By: kathleen

kathleen — Fri, 23 Jul 2010 15:46:14 +0000

As a youthful 55 year old, I have seen it all. In my youth, our pediatrician made house calls when we were too sick or infectious (chickenpox), visited me in a hospital after I had been injured in a car accident and years later tended to my ill child even though I resided in a different state and was only visiting.

In my 20s and 30s, raising children and working as a teacher, I had great insurance provided through my job which enabled me to pick & choose the doctors I felt most comfortable with. If my athletic child fractured a bone, I was able to immediately go to an orthopedic specialist.

Fast forward to 2010. I now pay a ridiculous amount each month to belong to a highly restrictive HMO. I have had to sever all ties with my doctors as very few take this insurance. When I tore a tendon recently, it took me 2 weeks to get a referral, and 3 weeks to get a walking boot. I had to go through a maze of visits in which each provider told me he was restricted by the insurance company from giving me a boot. This theoretically saved money. Insurance companies seem the biggest threat literally to the health of the patient. Profit seems to have robbed compassion.

With a daughter going forth into the field of medicine, I can only hope that someday we look back, re-evaluate the importance of the human connection, and find a better way to finance health care.

By: Marie

Marie — Tue, 20 Jul 2010 12:10:17 +0000

I’m not a proponent of PCMH’s. And I generally like what you have to say. But in this case, it is assumed a physician would actually be supervising someone operating under their license. So they would have presumably had a meeting with the staff member treating their patients and would have reviewed the chart and treatment together at the end of the day.

I’m not saying that you have the time to do this or that it is practical, only that this would be the expectation in a perfect world.

By: Gina

Gina — Sat, 17 Jul 2010 01:29:55 +0000

Isn’t chronic disease the 800-pound gorilla of healthcare? Non-physician teamwork sounds like the best way to deal with the myriad problems diabetics can have. I wonder how the money question will wash out in the long run? I knew a vibrant, energetic NYC entrepreneur who was unable to keep her diabetes under control. She had to give up her shop when her eyesight failed, went on disability, then required a wheelchair, next a leg amputation, finally death in her fifties. Besides the obvious tragedy, all of that cost money, too.

By: Gina

Gina — Sat, 17 Jul 2010 00:36:12 +0000

Hm, the NP’s in my state have sought repeatedly to get ANY independent prescribing authority (say for the many nursing homes where the scripts pile up until the once-a-week doc shows up to sign them). Guess who shows up every year to testify against the NP’s actually having any such responsibility (and liability)? That’s right, the state medical association.

By: John Messmer, M.D.

John Messmer, M.D. — Fri, 16 Jul 2010 15:06:49 +0000

The PCMH is NOT a system of farming out less complex patients to mid-levels. What it does is supplement the one patient – one provider (doc/NP/PA) model. One of the biggest issues facing us now is management of chronic diseases. Over a year ago, I started to participate in the PA Office of Healthcare Reform’s Chronic Care Initiative for diabetes. The idea is to use the standards of good practice (which, I agree, are subject to change – witness recent issues with BP control goals in diabetes) for the TEAM to focus on. Our diabetics are in a registry and we can focus on those whose HgbA1c’s, BP’s, LDL’s, etc are out of range, get people to the eye doctor, screen for nephropathy and neuropathy by identifying the patients and having a nurse or care manager arrange it. Extra meetings will be instituted by the care manager without my having to tell her to do it. EVERYONE on the team has the rules and the patient gets a regular report as to his/her progress.

The numbers for my patients have improved dramatically and I had thought I was doing a pretty good job prior to this.

Practice models tranform also. Do you realize how many practices in the US do NOT leave open same day appointments? So where do people go for acute illnesses? To the ED or urgi-center where more testing and referrals are done when they are not really needed.

The PCMH is PATIENT CENTERED, not physician centered. The old ways were costly and not sufficiently effective and were top down with the physician (or even the NP or PA) saying, “Do this!” and the patient either complying or not (we call them non-compliant if they do not comply). Now we work WITH the patient to identify and deal with barriers. And I don’t have to do it all; there are people to help.

Yes, I am in an academic practice and it is expensive to implement in small private groups or solo practices, but not impossible. It will require MORE MONEY from government and private payors. We now get extra money from the Blues for ALL our patients, not just diabetics, if we meet quality standards and we get extra payments quarterly for participation in the diabetic initiative. Small practices throughout PA are also participating and SUCCEEDING.

This is the future of medicine if we don’t screw it up through naysaying and complaining. Diabetes, hypertension, CHF, asthma, renal disease, seizure disorders, cancers – all can be managed through the PCMH while SIMULTANEOUSLY meeting the needs of patients for wellness, acute illness, etc.

Don’t knock it ’till you’ve tried it may be the best comment I can make.