NAME: Brian Bachelder, M.D.
TITLE: Associate Program Director, Akron General Medical Center, Ohio
Medical School: University of Minnesota, Minneapolis
Residency: University of Cincinnati
Internship: St. John’s Hospital, St. Paul, Minnesota
Bachelder practiced rural medicine for 25 years and was a pioneer in using electronic medical records. An Ohio native, he has been on numerous medical boards in several capacities. He has served as the Mount Gilead High School team physician since 1985 and received the Ohio Outstanding Team Physician Award in 2008.
A patient-centered medical home provides comprehensive, coordinated care centered according to patients’ preferred methods of accessing providers, among other factors. A hallmark of a patient-centered medical home is clear patient-provider communication with a central focus on health IT.
What do you like about the patient-centered medical home model?
I like everything about it. For the most part, it brings together all the facets that make family medicine so unique. Having been involved in electronic medical records very early on, I like to research the data to look at the patient population I take care of.
Then I make sure the individuals have all of their necessary preventative medicine and measures. I like electronic prescribing and the data tracking you can do for this to make sure patients have the tests and referrals done that I encourage them to do. I really like the information technology aspect, but the other aspects are equally important as well.
What’s the most challenging aspect?
It’s so easy to start looking at the computer screen and making data entries that you can lose track of the patient. Again, part of what makes family medicine so special is the patient relationships you develop. So having the computer between you and the patient can be a huge distracter for both you and the patient.
What’s unique about the model?
Most physicians think they are doing a great job when it comes to different parts of medicine. For example, every diabetic should have a Pneumococcal vaccine. I thought I was doing a very good job, but when I started entering all of the data into the computer, I found out that 20 percent of my patients had the vaccine.
So I made some changes in the practice, some interventions to improve the rate, and after six months, I was up to 98 percent and could name the two patients in my practice who did not have the Pneumococcal vaccine. This practice model allows you to do a much better job of tracking and ensuring patients are getting the treatment they need.
There are so many different recommendations these days for patients to make sure they are getting the preventive care they need, such as colon rectal cancer screenings or women getting pap smears. The computer is great for doing those boring, redundant tasks that may take long-term memory.
Was there anything about this practice model that surprised you?
Probably the toll on the staff. Whenever you go through a change in the office, it takes a lot of energy and effort. It’s not only for the physician’s part but for the staff’s part as well. It’s a lot of work and it can deplete the energy in the office if you let it. You need to make sure your staff is on board with this, they have the necessary tools, and that the expectations are realistic. It can’t be done overnight. It’s not a light switch you turn on and off. It needs to be done over a couple of years.
Starting a patient-centered medical home practice also is expensive. The electronic medical record we have been talking about is a very expensive proposition in terms of hardware, software and the amount of time updating those medical records on a daily basis. So you need to make sure if you are going through this process that there are payment mechanisms to justify doing this.
In the Akron, Ohio, area, the third-party payers are reluctant to pay anything extra for the patient-centered medical home. They want the benefits but aren’t willing to pay for them. I think they are slowly becoming more willing to pay, but they want to see a return on their investment.
Could a new physician choose this practice model?
I think there are aspects of this that would have a rapid return on their investment. Medicare is starting to pay for parts of a patient-centered medical home. An example is transitional care. These days, many physicians are not involved in hospital care, so there is a gap from when the patient leaves the hospital to when they are seen in the office. There is no one responsible for the gap. Residents take care of patients in the hospital and see them in the office, so they see the full circle of care that’s needed.
Having the experience of working with inpatients and seeing the gap in care before the patient gets to the physician’s office, they can see how the patient can get in trouble. They want to make sure they follow up on a daily basis making sure patients are taking their medications properly, have scheduled follow-up appointments and have adapted to their environments.
What advice would you give someone who wanted to open a patient-centered medical home?
It depends on the situation. When my residents graduate, I always want to know what their situation is going to be. If they are an in an employed position, such as a hospital or health care system, they need to know if the system has patient-centered medical home principles or is transitioning over and the level of care provided.
If they are going into private practice, they need to know if their partners have the same interest. If they go into a solo practice, they won’t be able to employ all of the principles right away but will develop the business practices down the road.
Anything else you’d like to add?
This is a culture; it’s an environment you create in your office on how you take care of the patient. An important part is the communication aspect, and one form of that is email. The problem with emails is that you have to watch the information shared in them.
The system is not always totally secure and can be read by someone else. Younger physicians use emails and texts so frequently that they need to be aware of the hazards involved. I caution my residents to be sure they know the potential risks of these forms of communication.