Health
Oschner Health Update: The Patient-Centered Medical Home
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By Dr. Keith Holmes
In my last article I wrote about why there has to be healthcare reform in our country. In short, the current healthcare system is unsustainable and will bankrupt our economy. One of the many new concepts on how to deliver better primary care in a cost efficient model is what is called Patient Centered Medical Homes (PCMH). As these PCMH’s are developed, no two will look exactly alike as they will be tailored to meet the needs of that particular medical practice. Despite being different, there will be many common traits.
One of the many hurdles facing delivery of primary care is a significant shortage of primary care physicians. That shortage, along with a large increase in patients that will be eligible for insurance, creates a double whammy. Where will the manpower come from to meet the need? Physician office’s will have to become more efficient and provide other avenues to meet the care that will be needed by their patients. For several years many practices have been meeting that need by using either Nurse Practitioners (NP’s) or Physician Assistants (PA’s) to provide urgent care for patients in their practice. NP’s and PA’s are usually referred to as mid-level providers. They work independently but with supervision of the physician.
In the past most practices have utilized mid-level providers to provide same day access for patients once the physicians’ schedule for the day has been booked. Thus making these providers the practice’s “urgent care” access point. This results in the patient not seeing the physician when he/she really is the sickest.
One model of care being explored is to utilize the physician primarily in a supervisory role overseeing the practices of multiple mid-level providers. Most practices would have one mid-level provider for every 2-3 physicians. The mid-level provider would then be utilized primarily to do routine follow up care for the patient’s diabetes, hypertension, high cholesterol, asthma, etc. In an adult primary care practice 80-90% of patient care centers around follow up care of chronic medical illnesses. By using the mid-levels to provide this type of care, it would free up the physician to see the patients when they are sick. The physician would still see the patients for routine care and physicals but every other follow-up visit would be scheduled with a mid-level provider.
There are other models of PCMH’s being explored and each has pros and cons. In summary though, each strives to deliver more comprehensive care at a reduced cost. Those young adults who are interested in healthcare and not sure they want to spend the time and money it takes to be a physician should really consider the opportunities of being either a NP or PA. The opportunities going forward are going to be immense.
Dr. Keith Holmes is a long-time Central resident and an internal medicine physician at Ochsner Health Center – Central. He can be contacted at 261-9790.
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