Concierge Medicine Today

PELZMAN, MD, MEDPAGE: ‘Let’s see what we can get done in 2015.’

By Fred N. Pelzman, MD    

MEDPAGE TODAY | JANUARY 9, 2015 – It’s the start of a brand new year, and while our healthcare system is still in somewhat of a state of disarray, there is hope on the horizon.

cmt  recommend 2015People are doing amazing things all over the map, trying out new models of care, getting healthcare done, bringing about change — patient-centered medical homes, direct care models, concierge medicine, accountable care models. From individual practitioners to massive care systems, small clinics to multi-hospital groups. From grassroots to government mandates.

Trying it all to see how we can make it better.

My home institution became an accountable care organization (ACO) starting on Jan. 1, and there is a feverish amount of work going on to help make this a successful project. As you can imagine, getting it up and running, like the building of the patient-centered medical home, has a lot of moving parts; it is a laborious process, but it can be a labor of love.

This is happening in the setting of new financial incentives aimed at providing support for primary care providers (PCPs) to provide care coordination for their patients. The promise of this funding, when you read about it in the official announcements, looks like a potential financial windfall for PCPs. But as we all know, when we put these things in place in large institutions, budgetary windfalls sometimes trickle down through many layers of administrative and bureaucratic filters before anything finally reaches the people in the field doing the work.

Now, none of us are doing this in hopes of making more money (although to be honest that would not be such a terrible thing), but we do want to make sure that the financial support provided to the institution ultimately leads to making the lives of our patients better, and the lives of all the members of our healthcare team better.

direct primary care journal2SMALLBecause as we have seen at times before, initiatives to bring about changing the way we practice medicine sometimes lead to an enormous amount of extra work for the people who are trying to do the hard job of taking care of the patients.

If the ACO brings us multiple new members of the team, care coordinators galore, community resources, massive builds of information technology infrastructure, and streamlining of the systems and processes we have been working on over the past few years, then this is definitely a good thing.

If all it leads to is more boxes we need to click in our electronic health record and more quarterly reports we need to fill out with mindless data entry, then count me out. We’ve seen this before, throughout our process of building the patient-centered medical home, and all too often the bureaucracy outweighs the benefit.

But if it can help us continue to grow the system, transform the system, to provide our patients with the care that are fractured healthcare system has proven unable to provide them with, then sign me up.

The more people looking out for our patients, the better. The more resources available in the community for them, the better. The more communication between patients and the multiple providers caring for them, the better. The more ways to prevent duplication of care, duplication of testing, and unnecessary emergency room visits, the better. The more access our patients have to us, to see us when they need to be seen, and to get the care they need in a timely manner, the better.

Let’s set ourselves to this task in the New Year, to helping move this project forward, with an eye on the prize of really transforming the healthcare system. This time let’s make sure we get it right, that all of the interested parties have a hand in the decision-making, as we keep a guiding hand on the tiller.

The last couple of years as we have moved towards changing our practice to a patient-centered medical home, we’ve seen the first crystallization of things getting better. The lives of our patients are improving, access to care is improving, transition of care is improving, the quality of the care we are providing is better, and the lives of all of the members of the team are beginning to move to a better place.

Let’s see what we can get done in 2015.


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