placenta does not belong in your hair

14th May 2009

Link reblogged from A Public Private Space

The physician - ahem - I mean PATIENT centered Medical Home →

Well said!

publicspace:

I got myself pretty worked up earlier this week about the NCQA Medical Home Recognition. What’s the big deal? I’ll try to explain.
The National Committee for Quality Assurance (NCQA) is a non-profit organization that sets standards of medical care. They come up with standards of care, and practices can apply to be accredited or recognized by them for meeting those standards of care. This theoretically helps patients and insurance companies pick and reimburse medical providers based on the quality of care they provide. Seems like a good idea, right?
The NCQA just released a new recognition called the “Medical Home”. Multiple physician run organizations had already congregated around the idea of a Medical Home, and define it as:
“a model of care where each patient has an ongoing relationship with a personal physician who leads a team that takes collective responsibility for patient care. The physician‐led care team is responsible for providing all the patient’s health care needs and, when needed, arranges for appropriate care with other qualified physicians.
A medical home also emphasizes enhanced care through open scheduling, expanded hours and communication between patients, physicians and staff.”
Gee! That sounds ideal! Pretty much what primary care is supposed to be!

The NCQA took this definition of the medical home and added a few more specifics about the need for electronic medical records and electronic communication systems. These make for better communication between providers and patients, and also help providers track patients with known diseases and make sure that they are meeting treatment goals.

Hmm. All of this sounds really good. And the amazing thing is that the Medical Home Recognition is a HUGE deal! Practices all over the country are scrambling to pull together the materials to prove that they are a Medical Home. If they don’t get this recognition, they are at risk of appearing neglectful to patients, and of losing insurance reimbursement.

But…this whole concept overlooks the huge role that Nurse Practitioners and Physician Assistants now play in the provision of primary care!

The Medical Home is a PHYSICIAN Recognition program, not a practice or provider recognition program. WHAT? This means that all of the scrambling I have been doing at work to adapt my notes to fit into the exact format that the NCQA requires is so that my physician colleagues can be recognized for the care I provide for MY patients? Yes, I am listed as their PCP on both their medical record and in many cases on their insurance card. Yes, I am their medical home. But I will not be recognized.

I spent this past week reading everything that I could find about the NCQA and the Medical Home concept in an effort to figure out what this is all about. Is it motivated by physicians who are threatened by other professionals who provide similar levels of care? Maybe. Probably. The NCQA board chair is the CEO of the American College of Physicians. There are several other physicians, and no nurses on the board. (Although interesting to note that the President and COO of the NCQA used to be a respiratory therapist and a registered nurse.) But in the process of “protecting” their profession, they are going to run primary care into the ground! Each year, fewer medical school graduates chose to go into primary care. And each year the number of NPs and PAs who could potentially help fill that gap increases.

If you are going to create a quality assurance program, make it applicable to all primary care providers. And recognize ALL primary care providers who meet those standards.

Anyhoo, now for the link. Pretty sure I’ve lost everyone by now except Arin anyway (hi Arin!).

For the second time in about a month, after spending several days getting myself very worked up about the state of my profession, I found an article that sums up how I’m feeling. And it does it much more eloquently than I can in my current angry, frustrated state.

Link is to a brief about how the Medical Home should include Nurse Practitioners - by a think tank pulled together by the American Academy of Nurse Practitioners.