Tag Archives: medical home

Pediatricians Lead the Way in Asthma Care

Busy physicians know that they can only do so much individually. Some health care problems are systemic issues. It takes a lot of people working together to tackle those. It takes a village, if you will.

Dr. Peterson (Photo by Sherry Boschert)

Individual pediatricians have been leading the way in developing some very encouraging collaborative, community-based programs to bolster “medical homes” for children, and especially to improve asthma care. Dr. Tom Peterson has championed one such project in Grand Rapids, Mich. It has brought more financial resources to physicians while decreasing children’s emergency visits by 12% and reducing hospitalizations by 14%. It’s been so successful that other counties in Michigan are copying it. See my full story for more.

Dr. Peterson modeled the Children’s Healthcare Access Program in Grand Rapids after a similar program that was started at Denver Children’s Hospital. He told me that in all the initiatives like this that he’s aware of, the effort starts with the actions of a single pediatrician who gets the ball rolling.

It takes a village, but it starts with individuals. Hats off to the docs who find time to take care of patients and to address the systemic needs. 

—Sherry Boschert (On Twitter @sherryboschert)

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Filed under Family Medicine, IMNG, Internal Medicine, Pediatrics, Uncategorized

Give Me a (Medical) Home: The Policy & Practice Podcast

While doctors are still peeved that there’s been no action to avoid the deep cuts in Medicare pay necessitated by the Sustainable Growth Rate formula, or SGR, the Obama administration has delivered some good news regarding a test of the Advanced Primary Care Practice concept, better known as the medical home.

For more on those stories, listen to this week’s Policy & Practice Podcast.

Not up to speed on the medical home? My colleague Mary Ellen Schneider can help you with that. As the medical home beat reporter for Elsevier Global Medical News—Notes From the Road’s sister news outlet—she’s covered the topic from most angles.

Image courtesy flickr user J. Steven Conn (CC)

Today, she wrote about an extensive test of the concept sponsored by the American Academy of Family Physicians; last week, she took a look at how specialists might lead the medical home for some of their patients.

See how much you can learn by reading Notes From the Road?

—Denise Fulton (@denisefulton on Twitter)
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Filed under Family Medicine, Health Policy, health reform, IMNG, Internal Medicine, Podcast, Practice Trends, Primary care, Rheumatology

Match Day Brings Good News for Family Medicine

Image via Flickr user Tulane Public Relations by Creative Commons License.

Happy Match Day! Earlier today, medical school seniors across the country learned where they would do their residency training. But today is not just about how medical students will be spending their next 3-7 years. It’s also about which specialties are hot… or not… in the eyes of future physicians.

This year’s results should make family physicians hopeful. The number of U.S. medical school seniors who chose family medicine residencies rose 9% over last year. This year, nearly 45% of the slots were filled by U.S. medical graduates. That’s the highest percentage of U.S. students entering family medicine since 2002, according to the American Academy of Family Physicians. Why the increase? Dr. Lori Heim, president of the AAFP, says it has something to do with the debate on health reform. With politicians, physicians, and policy experts all talking about the importance of primary care and the medical home, students are the getting the picture that being a family physician might be worthwhile.

The 2010 resident match results also indicate that areas like dermatology, neurological surgery, orthopedic surgery, and otolaryngology are some of the top choices for U.S. medical students, as they have been for many years.
Again in 2010, these areas were the most competitive, according to the National Resident Matching Program, with at least 90% of the available slots in each specialty being filled by U.S. medical school seniors.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

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Filed under Dermatology, Family Medicine, IMNG, Neurology and Neurological Surgery, Orthopedic Surgery, Otolaryngology, Practice Trends, Primary care

Walgreens’ Ill-Timed Entry Into The Diabetes Fray

The nation’s biggest drugstore chain, Walgreens, announced today that it is extending its many-tentacled health care strategy into diabetes care — a move that’s sure to irritate the nation’s endocrinologists, and perhaps primary care docs, too.

Courtesy of Walgreens

The company’s senior vice president of pharmacy told the Wall St. Journal that the company aims to enhance primary care physicians’ services, not replace them.  But the announcement comes at a time when primary care doctors are hoping to bring patients into all-inclusive, care-coordinated medical homes, not lose them piecemeal to various and sundry providers.

And, if the diabetic never makes it to the primary care physician — or only occasionally — he or she might not ever get referred to an endocrinologist.  Endocrinologists, in the quest for the diabetic patient, are also hoping to be the medical home care coordinator.

But endocrinologists are starting to feel like they might not get any patients at all.  A Medicare rule that went into effect Jan. 1 means that endocrinologists and other specialists are no longer able to bill for the extra time it takes to meet with a patient who’s been referred by a primary care doctor or other specialist.  These Medicare consultation codes were eliminated for 2010, in what some doctors see as a move to shift more dollars back to primary care.

The American Association of Clinical Endocrinologists (AACE) has led a petition drive to get Congress to adopt  Sen. Arlen Specter’s (D-Penn.) health reform bill amendment to delay the Medicare move by a year.  Gastroenterologists also joined the effort.

As far as physicians are concerned, there may never have been an optimal time for Walgreens to announce it was trying to take a piece of their business away.  But now seems an especially unpolitic time to do so.

— Alicia Ault (on Twitter @aliciaault)

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Filed under Endocrinology, Diabetes, and Metabolism, Family Medicine, Gastroenterology, Internal Medicine, Physician Reimbursement, Practice Trends, Uncategorized

Home Sweet Medical Home

Photo courtesy of Flickr user @cdharrison (CC).

Photo courtesy of Flickr user @cdharrison (CC).

from the American Academy of Pediatrics National Conference and Exhibition

 If the medical home model of health care ever comes to be, it looks like it’s the pediatricians who will get there first.  At least that’s the way it sounds based on comments of outgoing AAP president Dr. David T. Tayloe Jr., during one of the plenary sessions.

“When most of my adult friends become ill, they cannot get same-day sick appointments with their primary care physicians. They seek care from an urgent care facility or a hospital emergency department,” he noted. If these adults are very sick, they’re admitted to a hospital for care by a hospitalist team that is employed by the hospital or they are referred out of town for a higher level of care.  “None of these entities share the longitudinal health records of my adult friends. So their care is very fragmented and expensive,”  he pointed out.

“Contrast this adult medicine example, however, with the health care situation that exists in our community for the children and grandchildren of my adult friends,” Dr. Tayloe said. These children transition from the newborn nursery directly into pediatric practices, “where they DO receive comprehensive 24/7 care.”

Children “can have same-day sick appointments to avoid fragmentation of primary care.  They may be cared for in a hospital emergency department if all of our offices are closed … but the family has the opportunity to talk with one of our physicians before going to the emergency department,” he said. “If the emergency department staff needs to be seen by a pediatrician, our on-call pediatrician goes to the [ED].  If they’re sick enough to be admitted to the hospital, our staff provides hospital care such that the patient has a current, longitudinal record,” at the practice. Likewise, if pediatric patients require subspecialty care elsewhere, we make those arrangements and expect efficient communication from our subspecialty colleagues.”

“I realize that there are some underlying reasons for the failure of the adult medicine system to adopt the medical home concept,”  Dr. Tayloe conceded. These include primary care physician shortages and payment issues. “Even so, the mind-set of adult medicine is not the same as that of those of us in pediatrics. We are way ahead of them … in providing real medical homes for our patients.”

—Kerri Wachter, @knwachter on Twitter

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Filed under Emergency Medicine, health reform, Pediatrics, Practice Trends, Primary care