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Doctors get better at service

Banks have finally woken up to their customers’ needs for convenient hours – and today customer-focused service is making itself felt in some of America’s medical offices, according to Consumer Reports.

In these reorganized practices, evening and weekend hours are only part of the difference. If you’ve had a blood test or a CT scan, you won’t have to call the office half a dozen times chasing down the results. And if you leave the hospital with an incomprehensible “discharge plan,” someone from your doctor’s office will help you arrange your follow-up care.

If you’re already getting this type of service, you may be part of a “patient-centered medical home,” the fastest-growing innovation in medical care. More than 10 percent of primary care practitioners – about 27,000 U.S. doctors in 5,560 offices – are now recognized as “patient-centered medical homes” by the main accrediting group, the National Committee for Quality Assurance. Many thousands more are transforming their practices under other umbrellas.

Health care spending is a looming emergency. Within the next three years, more than 25 million Americans are expected to sign up for health insurance as the Affordable Care Act rolls out. And tens of millions of Americans born during the baby boom are heading into their medically expensive sunset years.

Other countries have solved the problem of costs by fiat. The prices that health care providers can collect for their services are established by the government (in Canada, France, Japan and the United Kingdom) or national cartels of insurers (in Germany).

Instead of national price controls, the U.S. is laying its bet on reforming the way health care is delivered and paid for. In the case of medical homes, in addition to the usual per-service fees for office visits and procedures, primary care doctors receive a little extra to defray the costs of setting up and running patient-centered care and may also share in any resulting savings if they succeed in keeping patients healthier and in less need of expensive care.

Consumer Reports notes that it will be years before we know whether these reforms really do save money and reduce deaths and disability from chronic illnesses. Meanwhile, it’s important that you know how these changes will affect what happens to you in the doctor’s office or during a hospital stay.

One of the major ideas for saving money is to put someone firmly in charge – usually a family physician, general internist or pediatrician – so that patients aren’t getting duplicative or contradictory treatments from a legion of specialists and so that doctors aren’t overlooking important and inexpensive preventive measures.

In addition to the 9-to-4 medical practice going the way of banker’s hours, Consumer Reports notes these hallmarks of a medical home:

• Efficient teamwork. In patient-centered practices, like Bon Secours Medical Group in suburban Richmond, Va., the process has been re-engineered, according to Dr. Andrew Rose, a family physician in one of its practice locations. First thing in the morning, the care team of doctors, nurses and medical assistants “do a daily huddle where we look at our schedule for the day and identify any particular needs the patients who are coming in may have,” he says. If a patient needs blood or urine tests, the nurses and assistants will take care of those before the doctor even enters the exam room.

• “Smart” medical records. For years, U.S. doctors lagged behind the rest of the developed world in computerizing their medical records, but that changed dramatically in 2009 when the federal stimulus bill brought forth more than $19 billion in funds to help practices go digital. The percentage of doctor’s offices with electronic medical records shot up from 42 percent in 2008 to 72 percent in 2012.

• Motivating patients. Ultimately, patients with chronic illnesses must participate in their own wellness, and medical homes are trying to make that happen.