When The Doctor Calls And It's Good News
Dr. Jay Fathi - Dr. Jay Fathi is a director of primary care at Swedish Medical Centers in Seattle, where one of the medical home pilot projects is taking place to see if a medical home can save money. (Keith Seinfeld/NPR)
When President Obama and other Democrats talk about changing the health care system, one phrase that comes up is "medical home." It's an attempt to reinvent primary care medicine and reward doctors who practice preventive care.
From a doctor's perspective, the medical home is not a place. It's a solution to a problem.
Under the current health care system, doctors "see as many patients as you humanly can in a day and charge the insurance company as much as you can per patient," Dr. Jay Fathi says.
(Keith Seinfeld/NPR)
What if, instead, Fathi says, doctors could see fewer patients in a day and focus on keeping them healthy — even bonding with them — and in return, they'd get paid extra?
Pilot Program
Fathi is a director of primary care at Swedish Medical Center in Seattle, where one of the many pilot projects across the nation is taking place to see if the medical home model can save money.
Its Ballard neighborhood clinic looks like any other medical office, and it is very quiet. Occasionally, the phone rings. The waiting room is almost empty. And that's how it's supposed to be.
"One of the goals of the medical home model is that you don't wait at all, that someone puts you right into the exam room, and people are there to see you right away," says Dr. Carol Cordy, the lead physician at the home. On their first visit, she says, patients spend a full hour with a doctor.
"It's really a luxury to be able to sit down and actually listen to a patient — and not have my own agenda because I have two or three more patients waiting," she says.
All medical homes offer some sort of extended visit.
"If you have a really short visit, your tendency is to order a bunch of tests because you don't have time to figure it out, and if you had more time, you wouldn't order all those tests," Cordy says.
A Patient's Perspective
That all sounded pretty good to Karri Patton. This spring, she walked in with a sinus infection that had been bothering her for more than a month.
"They know who I am, and they actually ask how you are feeling," Patton says.
Patton owns a nail salon and has no health insurance. Here, she pays a flat fee: $45 a month, which covers everything that can be done in this office, including most basic tests. "If I need something, I don't have to worry about how much is in the checking account, how much do I have left over to get myself medically treated," she says.
Her $45 doesn't include specialists or hospital care. For those items, she's on her own.
On the other hand, most patients at this clinic are covered by Medicare, Medicaid or private Blue Cross insurance, which also charges a flat monthly fee. Those patients can go to a specialist outside the clinic whenever they choose.
Other medical homes have come up with different payment schemes, but they all focus on easy access to care. As Cordy says, easy access is possible for so many patients because it doesn't have to be in the clinic.
"You are taking care of them in a different way, with telephone calls, with e-mail, so that your number of visits goes down because you are not seeing a patient as often," Cordy says.
Playing Medical Quarterback
Being accessible during off hours, via phone or e-mail, may also reduce the number of emergency room visits. If it does, it'll save money for the insurance companies, so they'll pay doctors a bonus the following year.
Insurers will also pay bonuses for keeping patients healthy. So, behind the scenes, the office is keeping track of patients, especially if they have a condition such as diabetes or asthma. Dr. Paul Grundy, the founder of a group that's promoting medical homes, says some doctors tell him they already do all that.
"One of the first questions I ask them is, 'Do you know every single woman in your practice [who is] over 50 and the status of her breast exams? And do you know every man who is over 55 and the status of his colonoscopy exams? If you don't, you don't have a medical home,' right?" Grundy says.
Grundy is an executive at IBM, which is pushing the medical home model as a way to keep workers healthier and save money. He says the primary doctor should be playing sort of a quarterback role, keeping tabs on what various specialists are all prescribing and taking care of medical questions that really don't need a specialist. That caught the attention of Dr. Peter Mandell and his colleagues.
"[Specialists] have concern that it's going to turn into a gatekeeper, that it's going to turn into an HMO-style of thing," Mandell, an orthopedist, says. "It doesn't have to do that. There can be ways figured out to make it work very well, but again, if it's going to be cost that's the No. 1 driver, there can be some bad things that happen."
Specialists aren't the only ones with concerns. Some family doctors may not be ready for behind-the-scenes changes, such as having a sophisticated electronic record system to monitor their patients.
The final judgment on the medical home approach will come from two measures: Are the costs really lower? And are the patients healthier and happier?
Keith Seinfeld reports for member station KPLU in Seattle.
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Maybe you've heard the term medical home in the current health care debate. The medical home model is an attempt to reinvent how patients and doctors interact with a focus on preventive care.
Keith Seinfeld of member station KPLU in Seattle visited a clinic that's already trying to do that.
KEITH SEINFELD: From a doctor's perspective, the medical home is not a place, it's a solution to a problem.
Dr. JAY FATHI (Director of Primary Care, Swedish Medical Center, Seattle): We literally say, see as many patients as you can in a day and charge the insurance company as much as you can per patient.
SEINFELD: That's Dr. Jay Fathi. He says, what if instead doctors were told, you can see fewer patients in a day, just keep them healthy, even bond with them and we'll pay you extra? Dr. Fathi is a director of primary care at Swedish Medical Centers in Seattle, where one of the many pilot projects across the nation is taking place to see if a medical home model can save money. The first two things I noticed at their Ballard neighborhood clinic are how it looks like any other medical office and how very quiet it is.
(Soundbite of ringing phone)
SEINFELD: Occasionally, the phone rings. It's not yet fully enrolled, so maybe it'll get a little busier. But in two visits, I saw in the waiting area a grand total of one person. And that's how it's supposed to be.
Dr. CAROL CORDY (Lead Physician, Ballard Neighborhood Clinic): One of the goals of the medical home is you really don't wait at all, that someone puts you right into an exam room and that people are there to see you right away.
SEINFELD: Dr. Carol Cordy is the lead physician here. She says on your first visit you spend a full hour with a doctor.
Dr. CORDY: It's really a luxury to be able to sit down and actually listen to a patient and not kind of have my own agenda because I've got two or three more patients waiting.
SEINFELD: All medical homes offer some sort of extended visit.
Dr. CORDY: If you have a really short visit, your tendency is to order a bunch of tests because you just don't have time to figure it out. And if you had more time, you wouldn't order all those tests.
SEINFELD: That all sounded pretty good to Karri Patton. This spring she walked in here with a sinus infection that had been bothering her for more than a month.
Ms. KARRI PATTON: They know who I am, and they actually ask you how you're feeling.
SEINFELD: Patton owns a nail salon and has no health insurance. Here she pays a flat fee: $45 a month, which covers everything that can be done in this office, including most basic tests.
Ms. PATTON: If I need something I don't have to worry about, you know, oh my gosh, okay, well, how much is in the checking account? You know, are all my bills paid? How much do I have left over to get myself medically treated?
SEINFELD: Her $45 doesn't include specialists or hospital care. For those, she's on her own. On the other hand, most patients at this clinic are covered by Medicare, Medicaid or private Blue Cross insurance, which also pay a flat monthly fee. Those patients can go to a specialist outside the clinic whenever they choose.
Other medical homes have come up with different payment schemes, but they all focus on easy access to care. As Dr. Cordy says, easy access is possible for so many patients because it doesn't have to be in the clinic.
Dr. CORDY: You're taking care of them in a different way, with telephone calls, with email, so that your number of visits goes down because you are not seeing a patient as often.
SEINFELD: Being accessible during off hours via phone or email may also reduce the number of emergency room visits. If it does, it'll save money for the insurance companies, so they'll pay doctors a bonus the following year. They'll also pay bonuses for keeping patients healthy. So, behind the scenes, the office is keeping track of you, especially if you have a condition such as diabetes or asthma.
Paul Grundy, the founder of a group that's promoting medical homes, says some doctors tell him they already do all that.
Dr. PAUL GRUNDY (Director, Healthcare Transformation, IBM): And one of the first questions that I ask them is, do you know every single woman in your practice that's over 50 and the status of her breast exams? Do you know every male who is over 55 and the status of his colonoscopy exams? If you don't, you don't have a medical home, right?
SEINFELD: Grundy is a doctor and executive at IBM, which is pushing the model as a way to keep workers healthier and save money. He says the primary doctor should be playing sort of a quarterback role, keeping tabs on what your various specialists are all prescribing and taking care of medical questions that really don't need a specialist. That's caught the attention of orthopedist Peter Mandell and his colleagues.
Dr. PETER MANDELL (Orthopedist): They have concern that it's going to turn into a gatekeeper, that it's going to turn into an HMO-style thing. It doesn't have to do that. There can be ways figured out to make it work very well. But, again, if it's going to be cost that's the number one driver, there can be some bad things that happen.
SEINFELD: Specialists aren't the only ones with concerns. Some family doctors may not be ready for behind-the-scenes changes, such as having a sophisticated electronic record system to monitor their patients. The final judgment on the medical home approach will come from two measures: Are the costs really lower? And are the patients healthier and happier?
For NPR News, I'm Keith Seinfeld in Seattle. Transcript provided by NPR, Copyright National Public Radio.
