Those who enroll and use a patient portal have different demographic characteristics and interest levels in selected portal functions than those who don't use one, according to a new AHRQ-funded study, "Consistency of Patient Preferences about a Secure Internet-based Patient Communications Portal: Contemplating, Enrolling, and Using," published in the Journal of Medical Quality. Although many patients may indicate interest, those who actually enroll and use portals may represent a unique subgroup of a practice's or health system's population. The article also suggests patients initially perceive only limited improvements in care because of the portal. (Journal of Medical Quality abstract)
Harvard Business School's Regina Herzlinger, the "godmother of consumer-driven health care," is less enthusiastic about other models of care, including the patient-centered medical home. "The reason PCMHs will not succeed is that...20 percent of patients generate 80 percent of the costs," she says. "Those 20 percent are the chronically ill, and I don't see how primary care physicians serving these patients add value to their care." She calls for "focused factories" of care--provider organizations that deliver highly specialized care for groups of patients with certain chronic conditions. They are, she explains, the opposite of ACOs "that do everything for everyone." (Managed Care Magazine)
Primary care doctors could get a pay raise next year for treating Medicaid patients, under a proposed regulation from the Obama administration. It would implement the two-year pay increase included in the Affordable Care Act. The increase, effective in 2013 and 2014, brings primary care fees for Medicaid in line with those for Medicare, the Washington Post reports. Although Medicaid is jointly funded by states and the federal government, the pay boost would be covered with federal dollars. (Washington Post)
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Even relatively affluent and well-educated patients feel compelled to defer to physicians during visits, and the fear of being categorized as "difficult" prevents patients from participating more fully in their own health care, according to research published in Health Affairs. The researchers also note that physicians can be authoritarian but "may not be aware of a need to create a safe environment for open communication to facilitate shared decision making." They conclude that rigorous measures of patient engagement--and of the degree to which health care decisions reflect patient preferences--are needed to advance shared decision-making. (Health Affairs)
After conducting three focus groups, research published in the Journal of the American Board of Family Medicine concluded patients want providers to know them personally and to take time to listen to their issues. Researchers also learned patients feel they cannot access their providers in a timely fashion--and want more time with them. They conclude that patients should be involved in the medical home transformation "to ensure we address their concerns and preserve the primary care relationships they value." (Journal of the American Board of Family Medicine)
April's Health Data Management assesses the struggling state of personal health records and the growing acceptance of patient portals. Although patient-controlled PHRs have not gained traction, the patient portal model has. While patients gain only limited direct access to their provider's electronic record, the messaging and scheduling functions are appealing. Reimbursement factors are also driving portal use. Increasingly, providers will be compensated on how well they manage patients with chronic conditions. The portal can help providers stay in touch with at-risk patients between visits. (Health Data Management)
The medical home concept may have begun in pediatrics, but it is also well suited for geriatrics, according to a review article in the Cleveland Clinic Journal of Medicine. Its features include many that have long been mainstays of geriatric care. The review outlines the patient-centered medical home's background and details some of the building blocks needed to get started on the NCQA certification process. It also describes the process of choosing the three required and clinically important conditions geared to an older patient population. (Cleveland Clinic Journal of Medicine)
Dr. Marjie Harbrecht, with the non-profit health consulting group HealthTeamWorks, and Julie Schilz, with Anthem-Wellpoint Health Insurance, discuss the medical home concept with Colorado Public Radio's Eric Whitney. The piece, "Home Sweet Medical Home," also talks about Colorado's selection to be part of the Comprehensive Primary Care initiative. Schilz discussed how the medical home has increased quality, which leads to lower costs. (Colorado Public Radio)
At the Patient-Centered Primary Care Collaborative's stakeholders' meeting, Gordon Harvieux, MD, a pediatrician and medical director of the medical home for Essentia Health in Duluth, Minn., shared how he collaborates with patients and their families to improve health care within his PCMH practice. It has four parent partners on its advisory committee. "They come to the table with us. We meet every two weeks. We ask them what needs to be done to improve health care in our practice, and we take their advice." The practice also put in a dedicated patient line for its most complex patients, AAFP News Now reports. (AAFP News Now)
Medicor Associates of Chautauqua N.Y., with offices in Fredonia, Dunkirk, Cassadaga and Cherry Creek; and Barnes Primary Care Associates with offices in Silver Creek and Angola, New York, have received NCQA medical home recognition. (the Observer)
Dr. Otis Brawley, chief medical officer and executive vice president of the American Cancer Society, speaking to the Association of Health Care Journalists, slammed everyone in the health care system for overuse of under-proven treatments. "Today we give doctors who do interventions in patients a lot more money than they should be getting and doctors who talk to patients very little money. The incentive on the doctor today is to not talk to patients, just move them in, move them out and get volume." (YouTube; edited transcript at Kaiser Health News)
MarketVoices…quotes worth reading
"We need to transform how we view health care. We need to become much more appreciative of prevention efforts. We need to reimburse doctors who coach and talk to patients far better than we are."
--Dr. Otis Brawley, chief medical officer and executive vice president of the American Cancer Society, speaking to the Association of Health Care Journalists, via YouTube; edited transcript at Kaiser Health News
