MEDICAL HOME – THE
IMPORTANCE OF PRIMARY HEALTHCARE
Family physicians at the forefront of organized
medicine's push to get their patients and US consumers a Medical Home, but
there are financial and legislative roadblocks to achieving this goal of the Medical
Home that could not only provide better patient care, but save the healthcare
system money and increase access.
Welcome to ReachMD XM157, The Channel for Medical
Professionals. I am Bruce Japsen, the healthcare reporter with the Chicago
Tribune and with me today is Dr. James King. Mr. King is President of The
American Academy of Family Physicians, the American Academy of Family
Physicians represents more than 90,000 doctors and medical students
nationwide. Dr. King is a family physician in Selmer, Tennessee, and has also
served three years as a director on the Academy's board of directors. He
serves on the volunteer faculty of the University of Tennessee's Center for
Health Sciences in Memphis. He is also on the medical staff of the McNairy Regional
Hospital in Selmer and serves as Medical Director of Chester County Healthcare
Services.
BRUCE JAPSEN:
Dr. King, welcome to ReachMD.
DR. JAMES KING:
Thank you Bruce, glad to be here.
BRUCE JAPSEN:
So tell us Dr. King, first, what is a Medical Home. For our
listeners out there, it seems to be a concept that we've been hearing a lot
even with folks running for president on the campaign trail, but I'd just like
to hear in your own words what is a Medical Home and that does that play in
this healthcare system debate that we are talking about this year.
DR. JAMES KING:
Well, a Medical Home begins with a trusting relationship
between a patient and their primary care physician or family physician that's probably
been done over time, but it's not only that physician, it's the entire
practice, in fact, it's the entire team of individuals that are supplying that
care. It may be the nurse that works with the physician, it may be the
pharmacist down the street that we write prescriptions and send to, it may be
the subspecialist, cardiologist, or gastroenterologist that we may work with in
way of providing that care. The Medical Home is a place that you can go to get
the service that you need, making sure that you see the right physician in the
right place at the right time to get the care that you need.
BRUCE JAPSEN:
And the Medical Home, how is that figuring into the
healthcare debate this year because often times when the presidential
candidates or folks running for congress, they just kind of throw that out
there, I don't think people generally know what it means, and if you could tell
our listeners or a lot of the doctors out there and patients, how is this
figuring in the healthcare debate and where is the Academy on this?
DR. JAMES KING:
Well, what is really coming into the debate in certain
areas, with the Medical Home we really truly feel that it is the foundation for
a value based healthcare system, but you kind of have to take a look at it and
realize to be able to provide that. (1) We have to have a primary care
based. We have to have enough family physicians out there to provide Medical
Homes to all of the citizens in this country, so it is working on trying to
provide that primary care, making sure that we have a place that people can get
preventive services they need, to help manage the chronic condition that they
may have, whether they be diabetes or hypertension or asthma, making sure that
we do take care of the acute problems, whether it be something minor like a
sore throat or an ankle sprain all the way to end-of-life things dealing with,
you know, cancer or whatever they might have. So, you know, someone that helps
them navigate through the system and all of the healthcare that we need. People
understand that as you increase the primary care base, what happens in your
healthcare system is a couple of things, that the quality improves as you have
more family physicians in geographical area and cost goes down because you're
providing those primary care services, those preventive services. You're
keeping patients away from the emergency room where it's more costly, you're
keeping them from being admitted into the hospital and having to be in the
hospital possibly, so you're holding down cost. We've seen that in all the
other industrialized countries, the quality goes up, cost goes down, but that's
based more on it being a primary care based system. In fact, there is research
now that shows in this country the same process as we increase the number of
primary care physicians then the quality improves and cost goes down. So we
understand if we can do that, then we can make some positive strides in trying
to improve the present healthcare system.
BRUCE JAPSEN:
How bad is it out there as far as our numbers, I mean, I
remember I've been writing about healthcare for a long time, I remember in the
early 1990s when the healthcare reform debate started in the Clinton
administration, I think there were efforts that they were talking about balancing
it so we had like 50% primary care and 50% specialists. Where are we now and
where do we need to head?
DR. JAMES KING:
We are nowhere near those numbers and that was numbers that
we were even talking back in the academy. We have looked at that and realized
that may be those numbers need to be readjusted. The American Academy of
Family Physicians did a research study and an evaluation of where we are with
our present healthcare system last year and what we found we're only producing
about 60% of the family physicians that we need, now that's even taking into
consideration the number of nurse practitioners, physicians assistants, the
general internees, the pediatricians, and others that provide primary care.
Even with those groups and the kind of numbers they are producing we are still
falling about 60% short of where we need to be in the way of producing primary
care physicians, so we still have ways to go.
BRUCE JAPSEN:
So based on the number of docs coming out of medical school
and residency, it should be 60-40 rather than what it is now?
DR. JAMES KING:
Well, no, I am not saying that, we're completing our
residency programs only about 60% of what family medicine needs to, that number
might be 40-60 with 40% primary care, that 50-50 number what we've start
realizing, okay, we took a step back and instead of trying to determine how
many primary care doctors or semi-specialists based on the total number of
American citizens we have to be able to provide a patient centered Medical Home
for each one of those, how many primary care providers we need and in doing
that what we've realized that we are just not producing enough family
physicians. It's not necessarily we're producing too many subspecialists, it's
just not enough primary care, so we need to raise that number by about 40% of
what we're producing right now.
So if you're just tuning in or if you're new to our
channel, you are listening to Inside Healthcare on ReachMD XM157, The Channel
for Medical Professionals. I am Bruce Japsen of the Chicago Tribune and with
me today is Dr. Jim King. He is the President of the American Academy of
Family Physicians and he joins us today from his offices in Selmer, Tennessee,
and we're talking about the legislative agenda, if you will, of the American
Academy of Family Physicians and one of the things that's key on their agenda
is hooking patients out there with a Medical Home.
BRUCE JAPSEN:
We've a huge problem in this country with people who are
uninsured and I would guess that most of those people do not have a Medical
Home, let alone a family physician, so Dr. King, what needs to be done in
Washington for starters to help to encourage this model and get patients hooked
up with the medical home?
DR. JAMES KING:
Well, they have to make several things, one is you've
mentioned a very valid point; there is 47 million uninsured people in this
country. Most of those people are delaying the care that they need, they are
not receiving any services they should and when they do get care, they get in
the most expensive place and they go to the emergency room, so we need to
develop universal coverage so that everyone has healthcare coverage that can
get them into the patients in a Medical Home and get their healthcare covered.
The other thing that they're gonna have to do is take a hard look at how they
pay physicians. Presently, they pay us only for face-to-face encounters.
Well, we know that you can provide high quality care in other ways, whether it
be using electronic means of communicating with your patients, whether you have
a team approach where other healthcare providers are providing certain services
using electronic health records so that we can use directories to make sure
that our diabetics get in and see us when they need to and supply information
to them, protocols, making sure that they are getting the preventive services
they need such as Pneumovax vaccines, cancer screening. So there is a lot of
different things that we need to work on to make sure that we're providing high
value in quality and not just necessarily quantity of healthcare.
BRUCE JAPSEN:
I know, and this seems to come up year after year, it's one
of those things where you just don't even know why it takes so much time to
even thing about, but of the numbers of people who are uninsured, are there
statistics on that, I mean, how many of them actually have a family doctor or a
primary care physician that they're seeing?
DR. JAMES KING:
On studies that when I do the interviews, most don't. I
don't have a specific number to say what percent do have a physician, but we
find that most of those individuals do get their care at urgent care centers or
retail health clinics or the emergency room instead of having a physician that
they see on a regular basis. Because that they really costs the system more
because when they do have to use the system, they are usually much sicker, they
end up being seen in the emergency room or being hospitalized where the cost is
higher, so that is a major problem that we need to work towards making sure
that they do have a patient-centered medical home that they can get those
services at.
BRUCE JAPSEN:
And how is the Medicare doing or even insurers in the
private sector on getting preventative care covered so it would be an incentive
for even people with insurance to come and see their doctor and their family
physician?
DR. JAMES KING:
They're not doing well now. They are starting, a hope to
hear the need for this. Many health plans don't cover for the preventive
services that need to be covered. We are starting to see a glimmer of hope.
They are starting to be pilot projects started both in CMS with the Medicare as
well as private insurers now looking at the concept of the patient-centered
medical home and to see if that helps control costs like we feel that it will
and to provide those services, so the process has begun. In fact, we've now
joined on with others in what's called the Patient-Centered Primary Care
Collaborative which is a group that started with big business who realized the
need for patient-centered medical home and IBM was one of the leaders in this
group, but the other groups like Xerox has signed on. We have many of the
major health plans that have signed on as well as well as business groups, the
healthcare industry. In fact, the four major primary care organizations, the
American Academy of Family Physicians, the pediatricians, the internists, and
even the osteopathic physicians which represent almost 333,000 physicians have
signed on with this concept. So the physician community has signed on, the
healthcare industry has signed on, the business community that pays for the
healthcare have. So it seems like all of the right players are lining up to
make this happen.
BRUCE JAPSEN:
Well, it's very interesting because the Medical Home is one
of the things that is constantly coming up out on the campaign trail that we're
hearing a lot about and Dr. King, if you will, if you were to get one thing in
front of the people running for office this year, what would it be that the
Academy would want them to hear and what patients and doctors should know that
the Academy is pushing in regard to the Medical Home?
DR. JAMES KING:
Well, the main thing that we're pushing is we've got to
begin the process of defining the Medical Home, determine exactly what it needs
to be and like I said the major primary care groups have signed on and we have
what we call the principles of the patient-centered medical home that helps
define that. We're beginning to gain support and then from a legislative
standpoint I think that they will need to take a look at different
demonstration projects, how can we change the way we pay physicians to make
this process work so we can improve quality and hold down cost, and the thing
over the years they're gonna have to do a couple of things is help the
physician communities to begin the process of changing into the patient
centered medical home. Not all of our practices are there now. It is very
expensive for the medical practice to put in electronic health record so
anything that the government can do to kind of help that process easier as they
began to add different components of the medical home to a practice would be of
great benefit as well and we ________ need to work together to move this
direction.
BRUCE JAPSEN:
With that I would thank Dr. Jim King who has been our
guest, he is President of The American Academy of Family Physicians and we have
been talking about the importance of the medical home and its role and its push
and as part of the legislative agenda this year in this election year in this
country. I am Bruce Japsen of the Chicago Tribune, I have been your host and
you have been listening to ReachMD XM157, The Channel for Medical
Professionals. We welcome your comments and question through our website www.reachmd.com which now features our
entire medical show library including the interview with Mr. King and on-demand
podcasts and I would like to thank you today for listening.
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