Changes in care coming

Published 9:08 pm Saturday, May 26, 2012

Doctor Fred Teixeira performs a checkup on Mayhue Wiggins at Vidant Internal Medicine, formally known as Pamlico Internal Medicine. (WDN Photo/Sara Cowell)

Changes are under way at some Beaufort County primary-care doctors’ offices that are expected to revolutionize medical care for patients in the coming months and, ultimately, encourage more medical students to choose to practice primary-care medicine.

The pending closure of

Inner Banks Urgent Care and the reassignment of its health-care professionals is part of that change, according to Clyde Brooks, vice president of medical affairs for Vidant Medical Group.

“This is about transforming the way we care for patients,” said. “It’s a complete reorganization of the primary-care medical office.”

Vidant Medical Group is a subsidiary of and reports to Vidant Health, and it includes 300 doctors in 65 medical practices, including and 15 primary-care offices across eastern North Carolina.

In the coming months, Vidant Medical Group will work to transform its Beaufort County-based primary care practices into patient-centered medical homes, Brooks said.

The patient-centered medical home is a new concept in primary-care medicine.

It will not only help to improve patient care but also prompt changes in the fee-for-services reimbursement practices that has led to a shortage of primary-care physicians in eastern North Carolina and nationwide, according to Fred Teixeira.
Teixeira is a doctor with Vidant Internal Medicine, formerly Pamlico Internal Medicine. His is one of the Vidant Health primary-care physician practices slated to begin its conversion to a patient-centered medical home this year.

“At patient-centered medical homes, patient satisfaction goes up and physician satisfaction goes up,” Teixeira said. “This is going to be the savior of primary care.”

The change to patient-centered medical homes will bring changes to primary care just as the designation of primary-care physicians decades ago as “gatekeepers” to more specialized care brought changes to the specialty.

In a patient-centered medical home, care is provided by a team of professionals led by a doctor.

Those professionals are tasked with who providing comprehensive and continuous medical care to patients with the goal of improving the overall health of the patient – including faster diagnosis and treatment of acute illnesses and better monitoring and care for chronic illnesses.

Patients will work with a range of medical professionals who “practice at the top of their license” to monitor their health and prepare for office visits, Brooks said.

And, unlike previously, when patients at some offices have had to wait weeks for an appointment, patients will be able to arrange same-day appointments if they need immediate care, Brooks said.

To qualify as a patient-centered medical home, a doctor’s office must meet standards established by the National Committee for Quality Assurance, a nonprofit organization based in Washington, D.C.

Those standards include the following:

  • Enhanced access and continuity of care such as same-day appointments, if needed, and the ability to provide patients with team-based care;
  • Improved patient management through, among other items, the use of electronic medical records and other improved record keeping;
  • Planning and management of patient care, including acute and chronic care management, including the ability to help patients manage their medications properly;
  • Providing support to patients to help them better manage their health-care needs;
  • Tracking and coordinating tests, referrals and transitions of care;
  • Measuring and improving performance by using patient-experience data for continuous quality improvement.

As medical practices work to attain these standards they will, in the coming weeks, add new doctors and implement changes, including transition to electronic medical records that will improve communication among doctors and their patients, Brooks said.

Such transformations are under way in Vidant Health-affiliated offices in Edenton and Wallace, where doctors have given the change high marks.

“This is very exciting,” said Dr. Mott Blair. “It’s a true system of care” that’s “embodied in the name itself.”

Patient-centered medical homes “give people a home where they can go if they’re sick or well,” he said.

Blair is a fourth-generation family medicine practitioner whose Wallace practice was acquired about three years ago by University Health Systems of Eastern Carolina, now Vidant Health.

His is one of the Vidant Health-affiliated medical practices that began the transformation to the patient-centered medical home last fall.

The transformation requires a “major practice redesign” that includes adding health coaches and patient-care coordinators to work with patients before, during and after visits to their doctors. That redesign also includes extended hours of operation and same-day appointments for patients, Blair said.

Operating a patient-centered medical home is more labor intensive than a traditional doctor’s office and requires a considerable financial investment and recruitment of additional health professionals that would not be possible for many practices without the support of a larger organization such as Vidant Health, he said.

“The real strength of Vidant Health is they have the ability to recruit and have the resources to implement the changes,” Blair said.

Joe Pye, a doctor with Vidant Family Medicine in Edenton, agreed with Blair’s assessment. Pye’s practice also began converting to a patient-centered medical home last fall.

The patient-centered medical home places more emphasis on wellness and monitoring chronic diseases in patients such as diabetes so minor health concerns be addressed before they lead to more serious issues, Pye said.

“There’s a lot about the care of patients these days that we do outside of the traditional office visit,” Pye said. “The patient-centered medical home is a blueprint for providing that care.”

“The traditional model of health care was that you treat sick people,” he said. “Today, we understand more about prevention and chronic disease support.”

Another aspect of the move to patient-centered medical homes is an expected change in the way primary-care physicians are reimbursed by insurance companies and other third-party payers such as Medicare and Medicaid, according to the Commonwealth Fund, a private foundation based in New York that seeks to promote better access and improved quality in health care nationwide.

Current reimbursement of doctors is biased in favor of procedures, such as surgery or imaging, and does not adequately pay for time spent with patients to take their medical history or follow up after the appointment, according to the Commonwealth Fund.

Teixeira agrees, saying that under the current system, primary-care doctors cannot take enough time to care for their sickest patients if their medical practices hope to remain profitable.

This system of reimbursement is, in part, responsible for a decline in the number of medical students who choose to enter the field of primary-care medicine and related disciplines, he said.

“Primary care is in a crisis,” Teixeira said. “The nation is not producing enough primary-care physicians of any stripe.”

Those practices that qualify as patient-centered medical homes may receive a case-management fee, tiered according to the extent and sophistication of office systems, and they may be paid for performance, based on delivery of optimal preventive and chronic-disease care, according to the Commonwealth Fund.

Such financial support should help bolster the field of primary care as well as improve care, the Commonwealth Fund maintains.

Teixeira agrees.

“If medical students see that we are doing patient-centered medical homes, they are going to want to do that and do that here,” he said.

Some health-care experts have expressed concern about the pay-for-performance aspect of doctor reimbursement.

Under a pay-for-performance plan, for example, doctors could be given bonuses if a certain percentage of diabetics have favorable quarterly test results or if patients avoid unplanned admissions within 30 days of their discharge from a hospital.

Since doctors are held accountable for patient behavior over which they have little control, these experts are concerned that patients who do not have favorable results could be released from a practice.