Saguaro Physician Offices Certified as Patient-Centered Medical Home

By M. Scot Skinner

The effort to provide patient-centric medical homes, complete with certification that you are doing so, is gaining traction at Saguaro Physicians.

Three of the TMC-owned group’s providers earned recognition recently from the National Committee for Quality Assurance: Drs. Kathleen Iveson, Wesley Vaughn and William L. Abraham.

As certified adherents of the Patient-Centered Medical Home philosophy, these doctors join a fairly exclusive club.

As of July 31, only a handful of Tucson groups are registered as medical homes, according to the NCQA, an independent, nonprofit group. Doctors at New Pueblo Medicine are listed, along with providers at Desert Star Family Medicine and several in the El Rio network.

It’s no coincidence that all of the above are fully on board with electronic medical records. The conversion to EMRs, which Saguaro Physicians completed in October 2009 and TMC completed in June 2010, is required before a practice can be deemed a PCMH. That’s because medical homes are built with EMRs at the very foundation.

“The EMR does a bunch of stuff for you,” says Dr. Richard Johnson. “It automates everything that can be automated. It tells you which patients are coming due for which test, and so much more.”

Johnson, Saguaro’s medical director, says that the medical-home model, which is delivered at no additional cost to patients, is particularly helpful for those with chronic conditions such as diabetes or high blood pressure. The many tools available through the use of electronic records greatly reduces the chances that patient needs will fall through the cracks.

It all makes for a return to something like old-fashioned care, says Johnson.

“The primary care provider becomes the integral part of your health maintenance, making sure you get the appropriate interventions at the appropriate times,” he says. “One of our catch-phrases is ‘Do the right thing for the right patient at the right time, every time.’”

The medical-home approach is being tested by UnitedHealthcare, which is nearing the end of a three-year pilot program in Arizona. The model is believed to be one of the best ways to get a grip on runaway medical costs. It’s getting a trial run, in one version or another, by insurers across the nation.

The idea is that by offering a home base for patients, coordinating their treatment and doing meticulous follow-up, doctors can reduce hospitalizations, prevent overuse of emergency rooms and lower medical spending overall.

“Life management is really what it is,” says Donna Bergman, Saguaro’s administrator. “It’s about making sure that we know what is going on with all of our patients. Because we are coordinated and fully connected with electronic medical records, it means that all of the records are immediately available to all of our doctors.”

The result of such coordinated care, achieved by making full use of nurse practitioners, physician’s assistants, nutritionists and other professionals, is that patients start taking better care of themselves. And healthier people, as it turns out, make fewer visits to emergency rooms.

The medical-home model also takes aim at the hordes who seek emergency care because their problem, while perhaps less urgent than a gunshot wound to the chest, honestly can’t wait for the next opening in their doctor’s schedule.

But what if patients knew they could call their doctor’s office 24-7 and get a next-day appointment? That’s a game-changer, says Johnson, and it’s the reality at Saguaro Physicians and other medical homes.

While only three of Saguaro’s 16 providers are recognized by the NCQA as a patient-centered medical home, all embrace the philosophy and have applied for certification.

“Most of the work in this area was done not just by the current people,” says Johnson, who has been with Saguaro for about two years. “Dr. Scott Van Valkenberg has been a driving force in this for a long time.”

The medical-home concept has won the support of the American Medical Association, the American Academy of Pediatrics (which introduced the term Patient Centered Medical Home in 1967), the American Academy of Family Physicians, the American College of Physicians and the American Osteopathic Association, among others.

According to Johnson, “everyone who provides primary care espouses the concept of the patient-centered medical home.”

So if this model is so promising for patients and providers, why isn’t it ubiquitous?

Because the conversion to electronic medical records is expensive for an independent practice, says Johnson, who estimates set-up costs at “anywhere from $40,000 to $100,000.”

“We are so fortunate to have the backing of TMC,” he says. “It can be a real struggle for those not affiliated with a hospital.”

But the expense of going digital is not the only reason why some doctors continue to drag their feet.

“Some providers just don’t want to change,” says Johnson. “They like doing things the way they’ve always done things.”

At least one group of doctors has taken the notion of patient-centered care to a surprising extreme, Johnson says. “There’s a practice in Seattle that got rid of its waiting room. They redesigned their offices in order to eliminate it altogether.”

The waiting rooms remain at Saguaro Physicians, but time spent there is minimal, he explains.

“If your appointment is at 1:30, barring any unforeseen issues, you’ll be seen at 1:30,” Johnson says.

Doctors who resist overbooking are the exception, not the norm, he acknowledges. “That’s not patient-centered care,” he says. “That’s physician-centered care.”

For more information about the patient-centered medical home, go online to www.ncqa.org

 M. Scot Skinner, an Arizona native, is an award-winning reporter with more than 25 years of experience in daily journalism. After a long career at the Arizona Daily Star, he is now working for Tucson Medical Center as a freelance writer. He can be reached at mscotskinner@gmail.com.

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