What a pleasant surprise to read in the New York Times a couple of days ago a short article called A Model for Health Care That Pays for Quality!

At the risk of sounding cynical, I was amazed that an organization of the stature of the National Committee for Quality Assurance should be sensitive to the pressing needs of the front-line doc and actually propose paying them for time spent caring for patients. And even more astonishing - pay them for time spent providing care and advice via the phone or online. Almost like you have to pay a lawyer! Not many big bureaucracies have had the time or inclination to heed the plaints of depressed healthcare providers.

Yes, it's true - read what the article says:

"The idea is to encourage doctors to meet with patients for more than a few minutes during an office visit and to also compensate them, or nurse coordinators, for communicating with patients by phone and e-mail outside office hours.

Doctors would also be compensated for helping patients manage chronic conditions — like reminding diabetic people to take their insulin — and would be encouraged to transmit prescriptions electronically."

There is however more to this story than the few lines above indicate.

The big meeting in Washington DC, alluded to in the article, was the Patient-Centered Primary Care Collaborative (PCPCC) Summit, a gathering of the constituents instigating (or inquiring about) the widespread adoption of an access and clinical delivery model -- the "Patient-Centered Medical Home" for patients.

From the PCPCC website:

"The Patient Centered Medical Home (PCMH) is an approach to providing comprehensive primary care for children, youth and adults. The PCMH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.

The AAP, AAFP, ACP, and AOA, representing approximately 333,000 physicians, have developed the following joint principles to describe the characteristics of the PC-MH.

...... Through the cultivation of comprehensive, interpersonal doctor-patient relationships, PCMH participants receive superior preventive care, disease management consultation, and lifestyle advice that will inevitably lead to healthier patients, alleviating the strain on emergency rooms and diminishing the need for costly, last-minute emergency procedures upon which many patients currently rely."

The catch  -- in order to benefit from the proposal for improved reimbursement, you would have to earn recognition as a "Medical Home" practice and meet the Joint Principles established by the four professional associations mentioned above.

How does this tie in with being an entrepreneurial physician?

One of the premises under which I work is that to be entrepreneurial is to be creative, thoughtful, and strategic about your practice. To treat it like a business that generates your income and that of all its employees, in addition to enacting its mission.

Therefore it's important to know what moves and trends are afoot that can impact your practice, and how you can capitalize on them.

If there are demonstrably better outcomes for patients belonging to a "Medical Home" practice, if they are more satisfied with their experience of you and your business, and if you can make more money doing the work you have to do any way, then it seems smart and entrepreneurial to take advantage of the opportunity!

To add your voice to the clamor for fairer compensation for your time as a primary care practitioner, contact your professional organization and urge them on in their efforts to work with the insurers and huge employers. And look into what it takes to earn recognition as a Patient Centered Medical Home -- it might just be your best business decision yet.

(Thanks to Jeff Van Ness at NCQA for his insightful comments and clarification of the issues).