Primary care focus of health conference ‘Medical home’ concept promoted

AUBURN – Primary care physicians are a dying breed. Pediatricians, internists, the iconic small-town family doctor and general practitioner – they’re all on the endangered species list, especially in rural areas. And yet medical experts are in agreement that these front-line health care providers should be the most critical and cost-effective component of our embattled health care system, the essential first line of defense when it comes to maintaining the good health of the nation.

At a daylong conference in Auburn on Wednesday, about 200 doctors, nurses, practice managers, policymakers and others gathered to learn more about reviving primary care through an emerging national model known as the “patient-centered medical home.” Especially for providing preventive care and managing chronic diseases such as heart disease and diabetes, the idea is gaining ground as the best way to ensure Americans get the medical attention they need.

“We need to bring primary care back to the center of the health care delivery system,” said conference presenter Dr. David Howes, president and chief executive officer of the Martin’s Point Health Care Center in Portland. Martin’s Point, the largest primary care practice in the state, is one of about 10 practices in Maine that will participate in a medical home pilot study, funded by private health insurers, the state’s Medicaid program and the Maine Quality Forum – a branch of Gov. John Baldacci’s Dirigo Health Agency. The study, which is still in the design stage, will ask participating practices to change the way they do business, starting with what happens when a patient calls for an appointment.

Instead of being subjected to a litany of personal questions while office staff try to determine how sick the caller is, how soon the caller needs to be seen and whether it’s possible to put off the appointment for a few days or longer, the goal will be to get the patient into the office that same day. Instead of confronting a crowded waiting room and a delay of a half-hour or more, the patient would be ushered immediately to an exam room and seen by the patient’s own doctor within a few minutes.

Other changes might include allowing the patient to review the doctor’s notes at the end of the visit, a follow-up phone call to see whether a new medicine is producing any unpleasant side effects, and an automatic reminder when it is time to come back for lab tests or a check-up. Extended evening and weekend hours and a 24-hour answering service offer additional clinical support for patients.

Such treatment might seem like the common-sense approach to dealing with patients and the complex needs they present, but Howes said it will require “an enormous cultural change” for busy physicians, many of whom are not used to working as part of a health care team, delegating certain tasks to nurses or other staff or seeking patients’ input on medical decisions.

Other presenters at the event included Melinda Abrams, director of the patient-centered primary care program for the Commonwealth Fund, a large private foundation that finances health care studies. Abrams discussed growing national interest in the medical home model, noting that Americans spend more on health care than any other country but don’t have better health to show for it. The medical home, she said, is increasingly being looked to as a way to improve health, save money and improve consumer and provider satisfaction with the health care system.

Dr. Xavier Sevilla, chief of pediatrics for Manatee County Rural Health Services in Florida, said patients at one public clinic used to wait an average of 66 minutes before seeing a doctor. Parents sometimes were told it would be two weeks before their sick children could be seen. After implementing medical home practices, patients almost always were seen the same day and waited only about 10 minutes before seeing their doctor, he said.

Dr. David Loxterkamp, a Belfast primary care doctor, heads up the only Maine practice to participate in a recently concluded national pilot project. Loxterkamp said his office, Seaport Family Practice, started up several patient support groups, assigned each patient to an effective doctor-nurse team, and implemented secure electronic medical records to which patients have access.

Loxterkamp said few young doctors choose to practice primary care, preferring more lucrative specialties instead. Policymakers and the medical community will have to find a variety of ways to make primary care more attractive, he said, or risk a serious shortage of providers.

The 11th annual Governor’s Summit on Cardiovascular Health was sponsored by a number of public and private groups, including the Maine Health Access Foundation, the state’s Healthy Maine Partnerships, the Maine Center for Public Health, Anthem Blue Cross and Blue Shield of Maine and the Maine Diabetes Prevention and Control Program.