In Premium Medical Home, we bring to the forefront these valuable and meaningful features of medical care which are often neglected.
We can briefly summarize six premium features of our model:
We believe that a direct relationship between the patient and their clinician is valuable and good. Directness also includes the other staff, nurses, and business staff.
…I’m (patients) sister. I’m so glad you are looking after my sister the way SHE wants! I am quietly in another state watching you being useful. Although I’m not on-site nor have anything practical to offer, I want you to know I’m grateful for your work, starting with the text and phone calls to me…
…I consider you to be my most trusted advisor about my most important possession – my health. I have no doubt that I owe my current good health and state of mind to the outstanding medical care and advice you have given me over the years…
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 clinician. Whether the communication is text messaging, email, telephone calls, cell phone or video calls, or office visits, patients and their families should choose what will be most valuable to them. Of course, communication is commonly through face-to-face appointments and sometimes with the nurse practitioner or assistants. But to promote a better medical practice for the patient, physician, and staff, giving the patient the choice to communicate directly as the patient thinks best promotes satisfaction and quality. We believe direct communication is something valuable to patients, families, and the physician and medical staff. Directness also offers convenience and simplicity, which is good for everyone. Directness is at the heart of a PMH experience.
Professionalism is a complex topic. Education, training, experience, and responsibilities are the essence of professionalism. But there is more to consider. Consider two scenarios:
In one, a patient with medical concerns is seen in the physician’s office. The patient is interviewed, examined, and care is recommended (directly or indirectly) by an internal medicine clinician who works with the best hospitals and consultants in town. This clinician has known the patient for some time.
In a second scenario, the patient is interviewed, examined, and care is provided by a clinician seeing the patient for the first time. In both, practitioners are providing qualified care as defined by insurance coding and the standard of care. But we believe that there are members of our community who will choose the first rather than the second scenario.
A doctor caring for patients is a person bringing their knowledge, experience, and expertise to help another. This knowledge and experience, the doctor’s expertise is not just about pills or guidelines or protocols. The doctor is the expert who can see the person as the complex irreducible soul that they are, meeting them, helping them, standing by them in their illness. Premium Medical Home exemplifies professionalism.
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 upon discharge, go to rehabilitation then to a nursing home, and then back to their own home. We believe that it is helpful to our patients, their families, and our colleagues for one physician to follow that patient, to go to their bedside, and provide their care in each of these settings. In a PMH practice, the physician maintains privileges at selected hospitals, nursing facilities, rehabilitation facilities and maintains an office for ongoing care. The physician will also make arrangements, where feasible and prudent, for house calls. This commitment on the part of the physician to go where his patient needs care promotes comfort, convenience, and value for patients and their families.
On a Saturday afternoon, a nurse in the hospital calls the physician for advice. The patient has suddenly developed new symptoms.
In one scenario, the nurse calls the same physician who saw the patient in the emergency room six days ago, continued care in the ICU, and then on the hospital medical unit.
In the second scenario, the physician 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 the case.”
These scenarios illustrate continuity and discontinuity. Physicians 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 physicians, all else being equal, value the first scenario compared to the second. There is value in continuity of care.
A PMH practice puts continuity of care at the heart of the clinician’s responsibilities.
In the Premium Medical Home, the physician should “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 physician can, in most cases, see or talk to the physician that day, even right away. If the family member calls and says, “Can you see my loved one who is ill?” The physician and his staff can say, “Yes, we can see your loved one.” The concept of not too busy goes to the idea of communication. If a patient or other family member calls the physician, it can be of great value to that person if the physician says, “I have time to talk.”
For a physician to be “not too busy,” the number of patients must be restricted, allowing a commitment to subscribers who count on Premium Medical Home. We will have to say no to many who ask, “Can you be my physician?” In a Premium Medical Home practice, the physician should run the practice so that he is not too busy and practices in a well-paced clinic. We recognize, of course, that emergencies can occur on weekends and when we are out of town or when our clinicians will not be in the office. Even the “not too busy” office from time to time must abandon a schedule for emergencies that arise. But the principle and the commitment are important.
At PMH, we commit ourselves to running the office so that we are not too busy, and that we can be responsive in a way patients and colleagues find helpful and valuable.
We believe physicians should consider the affordability of care. Where a patient advises the physician, “It is too expensive,” then we think the physician or their staff should offer intervention to find a better deal or consider options. We believe costs can be considered while also giving advice about medical options.
…as I recover, I want to thank you for your thoughtful care. I appreciated your daily hospital visits, good choices and constant care and understanding…
…I was impressed with your insight and ability to offer methods of achieving appropriate outcomes. This behavior is consistent with that of a true physician…
The PMH model is based on the value of loyalty, experience, and direct relationship between patient and physician. It is based on the idea that this experience can be offered by clinicians and purchased by patients who also value this. Premium Medical Home is a choice for patients who value direct relationships, continuity across levels of care, open communication, limited practice size, improved comfort, and convenience of both doctor and patient.
We believe comfort and convenience are important to all—patient, family, physician, and staff. Convenience includes the simple (for example), “What day would you like to talk about?” But on a more complex level, convenience includes considering:
- The location of X-ray or lab facilities
- How is best to include family in visits or consultations?
- Which referral sources would be best?
Comfort includes, for example, the peace of mind of the patient and family. Medical office visits, procedures, laboratory work, and seeing a new specialist can be anxiety-ridden and stressful at best and often just plain scary. PMH understands the need to provide information on the processes and procedures, patience, and kindness in order for you to feel more comfortable in any given situation. We can’t always know the outcomes of all medical processes and procedures, but PMH clinicians understand that the more you understand about your health and the process, the better equipped you are to lower your anxiety levels. Our goal is to make the unknown manageable, the treatments clear and outcomes understood.
Comfort and convenience are part of what we do every day. It is explicitly part of PMH.