At Home in Primary Care

In today’s world, getting some face time with your doctor can be a challenge. It can often feel like a game of musical chairs, as you hop from waiting room to waiting room, telling the same story to different people again and again. Once in the exam room, the time with your doctor is often a fraction of the time you spent waiting. And when your time is up, he or she must move on to the next patient, and the game continues…

The emerging concepts of the Patient Centered Medical Home (PCMH) and Ideal Medical Practice (IMP) were designed to solve some of these frustrations. Both models revolve around a patient-centered experience and extended face-to-face time in the exam room. The doctor gets to know the patient, and the patient gets to know the doctor. The office visit becomes a personal interaction, not simply a business transaction.

In addition, the PCMH and IMP models bring together all of the patient’s medical records under one roof to improve administrative efficiency and aid in the management of specialist visits. The primary care provider coordinates these visits—and their ensuing records and test results—so that no important information is overlooked.

A Brief History
The Patient Centered Medical Home is a growing concept, but not a new one. First introduced in 1967 by the American Academy of Pediatrics to emphasize the importance of centralized medical records for children with special needs, it has since evolved into a comprehensive primary care approach for children and adults, blending cutting-edge technologies with the old-fashioned, personalized care that family physicians have offered for many years. In short, under this model, the traditional doctor’s office becomes the central point for the coordination of healthcare.

In 2001, Dr. L. Gordon Moore started the Ideal Medical Practice movement when he left a large group practice to start his own independent primary care practice. Moore describes IMP as a combination of low overhead, high technology and excellent patient-physician relationships, in which face-to-face time between doctors and patients is key, physician workloads are reduced, patients’ responsibility for their health is highlighted, and wasted dollars are cut from the system.

Many of the principles of PCMH and IMP are shared or overlapping, most notably in their patient-centric approach, and they are largely compatible with one another. But IMP is also somewhat of a financial and process model that caters to small, independent practices, while most PCMH models re-engineer existing small and medium-sized practices to accomplish many of the same goals. In the IMP model, the physician spends more time with fewer patients—not always the case in the PCMH model.

Models in Practice
In 2009, after building two primary care practices and a stint in healthcare administration, Dr. N. Mike Jongerius wanted to return to family practice. But this time, he wanted to do it differently. After considering common complaints about lackluster patient-physician relationships, Dr. Jongerius knew the change he wanted to make. “The big question was: Is it a better way? That was what I wanted to answer.”

Now, as an independent physician with his own practice, Junction Medical, S.C., Jongerius is implementing the principles of the Patient Centered Medical Home and Ideal Medical Practice. As he took the leap into an alternative form of structuring a family medical practice, Jongerius still had questions. “If I had total authority over my practice and over how it was going to be structured, would it be sustainable and satisfying, and would patients see a difference?”

The difference to which Jongerius refers is the patient-physician connection, and a desire to get back to what family medicine used to be. The essentials upon which he focuses are:

• “Call today, be seen today.” Ninety-five percent of Junction Medical’s patients are seen on the same day they call in.
• Expanded office hours provides additional flexibility to patients.
• Maximizing face-to-face time and minimizing administrative hassles, ensuring that the patient’s and physician’s time is used efficiently. 
• Coordinated and comprehensive care. Medical records are kept in-office and Junction Medical coordinates specialist visits for the patient. 
• Patient-centered practice. The patient is always the first priority. 

It is, in part, a back-to-the-basics approach, with the primary care physician as the first point of contact in the healthcare system. But these concepts are “not a throwback to the Model-T Ford,” notes Dr. Jongerius. “[They are] actually trying to bolster or reinforce what people are looking for [in primary care].”

Patient-Centrism in Peoria
“When you come here, you see me,” says Dr. Jongerius. Upon arrival, patients aren’t shuffled from one room to the next, only to wait again and again; they are face to face with their physician within 10 minutes of the appointment. There are no switchboards to wade through; when calling the office, patients immediately talk to his sole full-time employee, Marilynn, or part-time employee, Marg.

Technology plays a key role in the structure and efficiency of PCMH/IMP practices. At Junction Medical, most lab results are available within 24 hours and can be emailed to patients. Patients can utilize email to schedule appointments, request prescription refills or simply ask basic questions about their healthcare. A computerized system is used for patient records and test reminders, to track patient and office management statistics, and as a tool to educate patients in their long-term healthcare goals.

Dr. Jongerius notes that larger medical groups are committed to providing the same service goals as the PCMH model, but in a small, independent practice, changes can be implemented immediately, and the results can be seen immediately. Now in the third year of his ideal practice, Jongerius is still learning from the daily challenges he faces, setting and re-setting goals for clinical performance and service so that Junction Medical continues to be a successful example of a PCMH/IMP primary care practice.

“The bottom line,” he notes, “is that having a regular source of care and continuous care with the same physician over time is associated with better health outcomes and lower total costs. That sounds like it makes intuitive sense. I would like to demonstrate that, and that it can be done right here in Peoria.” iBi

For more information on Junction Medical S.C., visit junctionmedical.com.

» Core Principles of an Ideal Medical Practice

• I can get care when and how I need it.
• I have a primary care provider (PCP) who knows me as a person.
• My PCP takes care of the bulk of my healthcare needs.
• My PCP coordinates any care I need in the health system.

Source: idealmedicalpractice.com

» Principles of the Patient-Centered Medical Home

1. Personal physician—each patient has one physician that provides continuous care.
2. Physician-directed medical practice—the physician is the head of the practice and manages his/her team. 
3. Whole person orientation—provides all healthcare needs during all stages of life and coordinates care with other specialists as needed.
4. Care is coordinated and integrated—patients’ needs are coordinated across healthcare systems, from hospitals to nursing homes.
5. Quality and safety—technology is used to the patient’s advantage, patients are actively involved in decision making and frequently asked for feedback to ensure their expectations are being met. 
6. Enhanced access—ensure that patients are able to communicate and see their physician through extended hours and electronic outlets such as email. 
7. Payment restructuring—break away from narrowly defined contractual fee schedules so that reimbursements reflect the value of the physician (improved outcomes, greater satisfaction) and resource investments (IT function). iBi

Source: The Patient-Centered Primary Care Collaborative