Spring 2014
PREMIUM MEDICAL HOME STORY by Robert H. Kelly, MD, FACP
The patient received a note from his pharmacy supplier that a critical brand name medication would no longer be covered. Early in the course of his illness, he had been unable to tolerate the generic version of the medication. The brand name was well tolerated and for 10 years had helped prevent serious illness. In addition, recent gastrointestinal complications had increased the risk of medication side effects. The patient came by the office to address concerns about changing medications.
Prior to the patient’s arrival at the office, Dr. Kelly had received information about the denial of medication coverage. A form had been completed requesting pre-authorization for the questioned medication. In the meantime, thought was given to whether or not a change in dose or change in medication would be acceptable.
Dr. Kelly called a neurology specialist. The specialist answered the call and said that he would be happy to see the patient in 15 minutes. A quick consultation was completed. The specialist thought it best not to change the medication or dose. We communicated these conclusions to the insurance company, and the needed medication was then authorized.
In the course of an hour, a serious question had been addressed, pre-authorization completed, and consultation done to confirm the course of treatment. This level of coordination is accomplished on a daily basis in many medical offices, but because of often crowded schedules, communication may be delayed. In large offices, different providers are tasked with different elements of the care, contributing to fragmentation of care and possible delay. In the Premium Medical Home, however, more often the physician and the patient will directly address and resolve these questions, promoting more rapid and less complicated resolution.
This is one of the benefits of a Premium Medical Home, providing not only for prompt medical care and recommendations, but also for the patient’s convenience and comfort.
DO PHYSICIAN EXTENDERS IMPROVE MEDICAL CARE? by Allan R. Kelly, MD, FACP
A report in the February 2014 Journal of the American Medical Association addressed whether adding more money and using physician extenders can improve medical care. The study, done in Pennsylvania between 2008 and 2011, looked at practices run by doctors based on their own judgment versus practices participating in a government designed program. The interventions in the latter group included bureaucratic creations like “breakthrough series learning collaborative,” “monthly quality indicator reports,” “practice coaches,” NCQAPPC-PCMH recognition with level one recognition required, and performance improvement efforts. More definitively, the Pennsylvania experiment offered doctors money, a bonus of up to $95,000 to each physician who hired a physician extender such as a nurse practitioner or physician’s assistant.
AMBIEN, XANAX, ATIVAN… by Allan R. Kelly, MD, FACP
A series of recent publications have examined the safety of “hypnotic” drugs, drugs like Ambien, Xanax and Ativan. This class of drugs is derived from Valium. They have been helpful in medical practice. Ativan, for example, has been used to treat anxiety, seizures, sleep disorder, and psychosis.
MARION EMERGENCY CARE CENTER by Robert H. Kelly, MD, FACP
Harris Hospital has opened the new Marion Emergency Care Center and an attached Senior Health Center. Until the opening of the Marion Emergency Room, Harris’s ER was plagued by crowding, hallway examinations, and long delays. These have been eliminated with the new Marion ER. The whole hospital seems to have refocused on the comfort and dignity of sick patients and their families while continuing to provide medical care.
COLON CANCER SCREENING by Robert H. Kelly, MD, FACP
The American Cancer Society recommends colon cancer screening after age 50. Cancer screening is commonly done either with fecal occult blood testing or colonoscopy. The American Cancer Society prefers colonoscopy because it is a more thorough exam. But despite being better, this recommendation causes some harm: recommending colonoscopy and neglecting the option of the stool test kit reduces the overall level of screening.
PMH QUOTATIONS Spring 2014
“The needs of the patient come first.”
Mayo Clinic
“Where the art of medicine is loved, there is also a love of humanity.”
Hippocrates
“That which is used develops. That which is not used wastes away.”
Hippocrates