When implementing PCMH, listen to docs - but talk to them too


The emerging patient-centered medical home (PCMH) approach to primary care is talked about a lot these days — but that doesn't mean everyone is necessarily eager to jump in head first. At the American Telemedicine Association's annual meeting, one project manager shared his tips for spurring adoption.

Leveraging smart and intensive use of health IT, a team-based approach, and provider-inspired patient empowerment, the PCMH model stands to be a crucial part of healthcare reform — one that rewards quality, not quantity, of care.

The ATA is especially interested in the model, thanks to the creative way it puts electronic medical records, home-based self-monitoring devices, online patient portals and other emerging technologies to use.

But in a healthcare industry where change is coming at a fast clip, many doctors are wary of the PCMH approach, viewing it as yet another potential disruption to their workflow, said John Wendland, project manager at the Carilion Clinic in Roanoke, Va.

So, having successfully transitioned to PCMH at his practices, he offered some advice for others thinking about getting similar programs off the ground.

For one thing, he said, remember that "physicians behave like any other population of people. There are those at the far right, at 2.5 percent, who are early adopters, have read the literature and are extremely enthusiastic about pursuing the implementation of the model.

At the other end, he said, is a roughly equal number of docs "who want nothing to do with it, don't want to be bothered and can't stand the complication."

In the middle "The other 95 percent of physicians are just waiting on the fence to see which way this will go."

As such, it's crucial to "let leaders lead," commented Wendland. "Let the early adopters go out and talk and proselytize."

And, when necessary, "exert peer pressure." Doctors, like anyone have egos. And someone who was the valedictorian of his or her class, went to a top medical school and has a successful practice likely won't want to be left behind in this brave new world. Peer pressure, he noted, "is an important tool."

Gaining physician buy-in is essential, and doing so requires project managers to "acknowledge and respect the burdens of the profession," said Wendland. (He even suggests having a counseling process in place.)

"You have to confront the 'one-more-thing' syndrome," he said. The pressures faced by physicians are well known, these days. Add to that the recent stress, for many of them, of going digital with health IT. And now, on top of it all, comes healthcare reform, with these new models of care.

Some doctors may be close to the end of their ropes with so many disruptions to the ways they're used to doing business.

No question, this makes life "more complicated for physicians," said Wendland, and ensures that they're more tied up in communication. "There is fatigue."

The key, he commented, is to "confront that head-on, and just have a serious, honest discussion."

"The life of the primary care physician is not really improved by the medical home," he admitted. "It's not going to make you incredibly more efficient. It's not going to let you go home at five o'clock. It's not going to take things away from your workload — in some cases it's going to add to your workload."

"But," he insisted, "there are rewards for doing it."

 

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