About Premium Medical Home
Medical care is part of everyone’s life experience. Whether it is as simple as a wintertime fever or cold or as complex as managing multiple serious medical problems simultaneously, we will all at some time seek medical care provided under the direction of a physician.
Physicians provide medical care of various types. For example, the obstetrician provides care for a pregnancy and the emergency room doctor provides care for an ER visit. These physicians limit their involvement to a specific time or diagnosis.
Internal medicine physicians can serve as consultants or as primary care physicians with varying models and philosophies. Premium Medical Home is our name for a particular philosophy or style of internal medicine primary care that we believe will be effective and satisfying throughout an adult’s lifetime.
Premium Medical Home is meant to provide qualities and aspects of medical care that are not explicitly provided by insurance and government programs. There are issues of convenience, comfort, and quality that are not described in insurance billing codes. For example, Medicare explicitly excludes “comfort and convenience” services from Medicare coverage. This is also true of other medical insurance. But comfort and convenience measures can be very important. We believe part of the stresses in the medical care system today are related to this exclusion of comfort and convenience features.
In Premium Medical Home, we bring to the forefront these valuable and meaningful features of medical care which seem currently neglected. We can briefly summarize six premium features of our model:
We promote directness. Directness is the quality of communication and interaction directly with your physician. We believe that a direct relationship between a patient and a doctor is valuable and good.
A direct relationship is promoted by modern communication. Premium Medical Home believes the patient should have a choice of how to communicate with his or her doctor. Whether the communication is text messaging, e-mail, telephone calls, cell phone calls, or office visits, patients and their families should choose what will be most valuable to them. Of course, communication most commonly is through face-to-face appointments, and sometimes through the doctor’s assistants and nurses. But to promote a better medical practice for patient, doctor, and staff, giving the patient the choice to communicate directly as the patient thinks best promotes convenience, comfort, and quality. We believe direct communication is something valuable to patients, families, and the doctor and medical staff. Directness is at the heart of a PMH experience.
Professionalism is a complex topic. As illustration, consider these scenarios. An 86-year-old patient with hypertension, diabetes, and now high fever, is seen in the doctor’s office. In one scenario, the patient is interviewed, examined, and care is recommended by a board certified internal medicine physician who is on the staff at the best hospitals in town. His education, training, experience, and responsibilities are the essence of professionalism. This doctor has known the patient for some time. In a second scenario the patient is interviewed, examined, and care is provided by a physician’s assistant or nurse practitioner, new to town, unfamiliar with the other doctors, and with less than one year of experience. Both practitioners are providing good care as defined by insurance coding and the usual standards of care. But we believe that there are members of our community who will choose the first scenario rather than the second scenario. Some would have no preference, and would just as soon see the provider who could see them most conveniently and the level of professionalism is immaterial.
We believe there should be practices in our community where patients and their families know that they will be seen by the board certified physician. Not necessarily because that is better care than the alternative, but because that is the choice of the patient and their family, because they put more value in certain characteristics of education, training, experience, and responsibility. Professionalism is the totality of education, experience, reputation, responsibility and training. Many people see professionalism as something they want and value in a physician.
CONTINUITY OF CARE
Continuity of care is valuable to patients and their families. It has been shown to yield better outcomes. Continuity of care in the PMH practice involves not only caring for the same patient from year to year, but also caring for the same patient as they travel through different places where care is provided. For example, a patient can become ill, be admitted to the hospital, and on discharge go to a rehabilitation hospital. They can go from the rehabilitation hospital to a nursing home, and then from the nursing home back to their own home. We believe that it is helpful to our patients, their families, and our colleagues for one doctor to follow that patient, to go to their bedside and provide their care, in each of these arenas of medical practice. In a PMH practice, the doctor maintains privileges at selected hospitals, nursing facilities, rehabilitation facilities, and maintains an office for ongoing care. The doctor will also make arrangements, where feasible and prudent, for house calls. This commitment on the part of the doctor to go where his patient needs him promotes comfort, convenience, and value for patients and their families.
Continuity of care can also be illustrated by an example. On a Saturday afternoon, a nurse in the hospital calls the doctor for advice. Her patient, Ms. Jones, has suddenly developed a fever and is vomiting. In one scenario, the nurse calls the doctor who saw the patient in the emergency room six days ago, took care of her in the ICU, and then transferred her to the floor where he made rounds and saw her earlier in the morning. In the second scenario, the doctor is on call, and has not seen the patient, and on being called by the nurse says, “You’ll have to tell me a little bit about this patient. I don’t know her.”
These scenarios illustrate continuity and discontinuity. Doctors and nurses are highly trained professionals and they can deal with new patients that they don’t know very well. They can make good decisions. But we believe patients, families, nurses, and doctors, all else being equal, generally prefer the first scenario to the second scenario. In other words, many involved in the care of the sick recognize that there are certain qualities and values in continuity of care. This we believe is at the heart of a Premium Medical Home experience. A PMH practice puts continuity of care at the heart of the doctor’s responsibilities.
NOT TOO BUSY
In the Premium Medical Home, the doctor should be “not too busy.” What this means in a Premium Medical Home practice is that a patient who is ill and needs to talk to or see the doctor, can see or talk to the doctor that day, even right away. If the family member calls and says, “Can you see my loved one who is ill?” The doctor and his staff can say, “Yes, we can see your loved one, we are not too busy.” The concept of not too busy goes to the idea of communication. If a patient or other family member calls the doctor, it can be of great value to that person if the doctor says, “I have time to talk. I am not too busy.”
For a doctor to be “not too busy,” he must restrict the number of patients for whom he is responsible. He must make a commitment to those patients and their family members who count on him, understanding that he will have to say no to people who say, “Can you be my doctor?” The commitment is to those persons for whom the doctor already has a responsibility. In a Premium Medical Home practice, the doctor should run the practice so that he is not too busy, even while in the midst of a well-paced clinic. We recognize, of course, that emergencies can occur and even the office dedicated to the concept of “not too busy” from time to time can be forgiven for the emergencies that arise. But the principle and the commitment are important and can inform choices and plans.
At PMH we commit ourselves to running the office so that we are not too busy, so that we can be responsive in a way patients and colleagues find helpful and good and therefore of value.
Medical care today sometimes is extremely expensive. People hear about CT scans and MRIs that cost thousands of dollars, drugs that cost many thousands of dollars, even for a one month supply. Emergency room visit charges can be in the tens of thousands of dollars, and hospital visits in the hundreds of thousands of dollars. All of this leads to the impression that medical care is unaffordable. Sometimes, there seems to be a principle of maximizing prices charged to insurance companies, and patients and their families are surprised by very high prices.
At PMH we look at things differently. We believe that good medical care should be and can be affordable. At PMH, we restrict the number of patients in the practice so that we can achieve our goals as outlined on this website. The practice is committed to persons who subscribe to PMH on an annual basis.
We want to offer PMH to people in a fashion that is affordable to them. Our subscription fee is not exorbitant, designed only for the rich. At PMH, we keep our annual subscription fee scaled to be age appropriate and there are special fees for individuals, couples, and children in the home between 18 and 26 years of age.
We believe that this annual subscription is affordable and reasonable to many and allows the doctor to run a better medical office, an office committed to the comfort and convenience of the patient. This, we believe, is a premium worth paying for.
In our Premium Medical Home practice, we optimize practice size for your convenience, comfort, and direct doctor-patient relationship. A smaller practice means foregoing increased business based on volume. It means deciding to place more value on each patient’s time. Many doctors and patients alike experience a sense of delay and even chaos in their medical care, whether in the emergency room or a very busy clinic. Often patients experience long waits and at times a feeling of anonymity.
By restricting patient size, Premium Medical Home values and acknowledges each person’s time, individuality, and comfort.
Our small professional offices are designed for patient comfort and convenience. When you invest in the PMH subscription, you receive directness, continuity of care, professionalism, “not too busy,” and affordability. This style, care, comfort, and convenience is not a medical service. For PMH subscribers, it is like having a doctor in the family. With an affordable PMH subscription, you don’t have to be rich to get directness, continuity, professionalism, and better scheduling.
Our small office provides convenience, such as front door parking, walk-in appointments with your physician when needed, and the ability to talk on the phone to a real person right way. Patients can expect prompt attention, can book appointments for the same day, and know their questions will be answered personally. Your time is respected. In your Premium Medical Home, when you need a doctor’s services, we will respond.
When you have a question about your health, you want timely answers, with a prompt and personal response from your physician. For PMH subscribers, it is part of the package. An annual PMH subscription buys the added convenience of a premium experience at an affordable cost.
In your Premium Medical Home, we provide you with professional medical care whether you are in the office, hospital, emergency room, or nursing home. We also work with your insurance efficiently. Your insurance is important to you, and we work within that model. We believe many patients and their families want the doctor who knows the patient best to care for that person in the facility that best serves the patient. The internal medicine doctor who limits himself just to the office will miss many opportunities to support and care for his sick patients.
In the PMH practice, your primary care physician is available not only in case of emergencies or illnesses, but also for wellness. Good health begins not with diagnosis and treatment, but with maintaining your health from day to day. Premium Medical Home wellness planning and recommendations for a healthy lifestyle promote good health and staying out of the doctor’s office. We are committed to helping you obtain reasonable and effective preventative care. Studies show that a stable and trusted doctor patient relationship promotes better health outcomes. We focus on working with you to maintain your strength and to prevent disease.
As a PMH subscriber, your medical care and advice are available to you when and where you need them: In town, traveling, by phone, by e-mail, or by text message.
The PMH subscription covers many premium features. The PMH@Home Newsletter is available only to PMH subscribers. It focuses on effective prevention and medical care strategies. Your PMH subscription extends your medical care, and we believe is a premium worth paying for. As part of your premium experience, you can expect that prescription refills will be provided at your convenience, wherever you are, at home or on the road. The experience for PMH subscribers includes attention to out of town guests who find themselves in need of a doctor while visiting the PMH subscriber. If an out of town guest needs medical advice, you can call your PMH doctor and he will help you. This, again, is a premium worth paying for.
With PMH, we try to bring new value, starting with comfort and convenience, to your relationship with your doctor. We focus on directness, professionalism, continuity of care, not too busy, affordability, and a premium experience. This is not meant to be a complete description, but six features we value. The ancient, respected, and valued relationship between patient and physician cannot be completely described with six bullet points. Nor can the doctor patient relationship be described with insurance codes. At PMH we want to run an office that you will find better and that offers value to you and your family.