Archives
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Patient-centered medical home: Are we or aren’t we?
By David W. Bauer, M.D.
When is a patient-centered medical home not a patient-centered medical home? In my practice, the answer is “every day.” In 2009 we received NCQA’s designation as a Level 3 PCMH. To achieve this, our physicians had to document ways in which our patients had enhanced access to our practice, provide examples of how we use evidence-based guidelines to provide quality care, demonstrate the means by which we coordinated care across time and space, and a number of other measures. We do, in fact, do those things every day. What we don’t do, is do all of them for every single patient, every single day.
Consider the analogy of a patient with diabetes whose hemoglobin A1c is 6.9. We would say that the patient’s diabetes is well controlled and congratulate the patient. But there are many ways that a patient could achieve this value. One would be to have very little fluctuation of her glucose from hour to hour. Another would be for the patient to drop into the 40s overnight, and climb to 200 immediately after meals. The hemoglobin A1c is an average, and doesn’t factor in variation. For years, decreasing variation has been the mantra of those working to improve quality, increase efficiency, and decrease medical errors in the hospital setting. As we migrate toward a new model of health care in this country—the PCMH—it would be valuable to embrace this concept in our offices as well.
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Protecting our most vulnerable
By I. L. Balkcom IV, M.D.
TAFP President 2012-2013Her name was not important. This little 6-year-old girl I had been called to examine in the emergency room now sat silently, flanked by her mother and mother’s boyfriend.
I was in my third year of residency and was summoned to evaluate this patient who I’d been told had fallen in the bathtub at home. She had a large bruise around her left eye.
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Best practice: What one Austin practice is doing about obesity
By John K. Frederick, M.D.
If your clinic is anything like ours, we are being deluged with obesity and its downstream effects of diabetes, hypertension, obstructive sleep apnea, and heart disease. New evidence surfaces almost daily in the medical literature describing some new correlation between obesity and negative health consequences. This situation is also discouraging because there aren’t many good community resources that are both easy to access and effective. The inertia of poor diet and lack of exercise is overwhelming. Repeated advice and encouragement often seem useless, and eventually it feels as if there is no point. Even the employees in our own clinic seem to be disproportionately affected with this condition.
Several factors contributed to our recent action. Perhaps it was seeing how fast the box of doughnuts emptied in our break room. Or, maybe it was the Medscape article pointing out that overweight doctors tend to spend less effort on recognizing and treating obesity. That hit close to home!
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ICD-10 delay in the works
By Kent Moore
With 5010 implementation effective Jan. 1, 2012, the next major hurdle facing physicians and the rest of the health care system is implementation of International Classification of Diseases, 10th Edition (ICD-10). Currently, that is slated to happen on Oct. 1, 2013.
Or is it? In mid-February, officials at the Centers for Medicare and Medicaid Services (CMS) and Health and Human Services (HHS) announced that a delay in implementation may be forthcoming. First, acting CMS Administrator Marilyn Tavenner told reporters that the CMS will “re-examine the timeframe” for ICD-10 implementation through a rulemaking process. She did not say when that rulemaking process will begin, and she did not actually say that implementation will be delayed.
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