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Latest Posts

Many primary care practices wish to become patient-centered medical homes, but the transformation process can be daunting. Here, three experts offer some professional advice.

By Joan D. Johnston, R.N.; Jaime Vallejos, M.D.; and Jeanne Cohen, R.N.

As soon as we walked through the doors of the urban community health center that we were going to help achieve patient-centered medical home recognition, we saw a practice that was passionate about obtaining the recognition, but overwhelmed to the point of paralysis. We are a team of certified patient-centered medical home content experts from the University of Massachusetts Medical School. In our work with health care organizations and practices seeking NCQA recognition, we are always reminded that achieving this designation requires thoughtful planning, strategy and commitment. Through hard work and with our support and guidance, the community health center achieved Level 2 recognition from the National Committee for Quality Assurance (NCQA). And they learned it doesn’t have to start out so difficult. 

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Posted by Sonya Collins on Aug 28, 2014 11:21 AM EDT
As a National Health Service Corps scholar, Kohar Jones was required to serve for a few years after residency in a federally qualified health center. After her service was complete, the medical director was surprised that Jones planned to stay. Here, she explores ways to create practice settings that primary care providers won't want to leave.

By Kohar Jones, M.D.

Here’s a central difficulty of the Affordable Care Act: If everyone has access to health insurance, then everyone has access to all the medical care they need. Curing sickness and preventing death cost a lot, and our country can go broke in the process. We save money and lives when everyone sees a primary care doctor who works to keep people well. But we don’t and won’t have enough primary care providers in the United States to meet the needs of all those who now have access. We’re already facing a shortage. The Affordable Care Act is only going to make it worse.

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Posted by Sonya Collins on Aug 26, 2014 12:05 PM EDT
At Primary Care Progress, we believe that innovation can transform primary care from a field that breeds burnout to a field that brings joy to its practitioners. Students, trainees, and young clinicians should be leaders of such innovation. In this piece from our archives, two med students describe a program that trains future doctors to be innovators, too.

By John Luo and Jeffrey P. Guenette

Technologies in the field of medicine have grown exponentially in the past few decades. Stemmed by a growth in our knowledge of disease pathology, incentives from governmental granting agencies for translational research, and rapidly advancing technical and engineering capabilities, the role of the physician as innovator has never been more important. Physicians have played a significant role in the creation of a wide variety of medical tools from drug therapies to electronic health records. It is estimated that over 20 percent of all patented medical devices were invented by physicians. And, perhaps surprisingly, roughly 60 percent of physician-inventors are at private practices versus in academic settings, according to a Duke study

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Posted by Sonya Collins on Aug 21, 2014 11:15 AM EDT
Even after your formal training is complete, this family physician says it's still normal to ask yourself, "When will I feel like a real doctor?" 

By Randi Sokol, M.D., M.P.H.

In medical school I used to ask myself, “When will I feel like a real doctor?” During intern year, I asked the same question. Now as a new faculty member who has completed medical school, a family medicine residency and a teaching fellowship, I still find myself asking that same question.
 
As primary care doctors, we are trained to churn out differential diagnoses. We must avoid premature closure or incorrectly assuming one diagnosis or management strategy without considering other less obvious possibilities. Much like House in his intellectual detective-like pursuit, we are taught to order every test, no matter how obscure, until we can solve the case. 

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Posted by Sonya Collins on Aug 19, 2014 11:44 AM EDT
Robin Williams' death this week reminds us that mental health conditions are often unseen. What's more, our health care system is designed in a way that allows people living with these conditions to fall through the cracks - their problems only visible to others when it is too late. In this post from our archives, Benjamin Miller explains how this happens and how we can stop it.

By Benjamin Miller, Psy.D. 

Imagine this scenario. You go to see your longtime primary care provider. What you have to say you could only say to the person who has taken care of you and your family for years, has seen births and deaths. It’s still hard to say. In fact, you never thought you’d have to say it. But ever since you lost your mother, you’ve not been feeling your best. You’re eating foods you know aren’t good for you. You’re sleeping too much and not exercising at all. Your blood pressure is the highest it’s ever been, and your weight is becoming a problem. You feel down most of the time, and you’ve stopped doing the things you love. It was actually your neighbor that asked, “Are you depressed?” 

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Posted by Sonya Collins on Aug 14, 2014 12:16 PM EDT
Many members of the PCP community attended the Direct Primary Care Summit in Arlington, VA, this summer. We'll be sharing their perspectives here over the coming weeks. Today a medical student questions the accessibility of direct primary care.

By Brett Clark

One of my main interests in primary care is providing care to all people, regardless of their income or ability to pay. In my limited experience with health care, I have found it most rewarding to work with the underserved and underprivileged, those who do not have their own money available to allocate to health care. These patients are on Medicaid or are at the mercy of free clinics. This is why I have always had a poor opinion of concierge medicine. In this model, patients pay an annual fee or a retainer to their primary doctor in exchange for their medical care, and they may incur additional charges for labs or when their care exceeds the retainer. This is care for people who can pay for it. 

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Posted by Sonya Collins on Aug 12, 2014 9:55 AM EDT
In today's Progress Notes, this physician puts a positive spin on a negative review of the patient-centered medical home.

By Ira Nash, M.D.

There is an old gag about an intensely optimistic child whose bright outlook on life is so irrepressible that when he is presented with a room full of manure for Christmas, he screams with delight, convinced that there “must be pony in there someplace.” I was reminded of that when I read a recent study, “The patient-centered medical home, electronic health records, and quality of care,” and the accompanying editorial, “Is there value in medical home implementation beyond the electronic health record?” in the Annals of Internal Medicine.

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Posted by Sonya Collins on Aug 7, 2014 1:36 PM EDT
Here at PCP, we encourage med students and trainees to use community organizing to gain the training opportunities they need and to create a culture that fosters their choice to pursue primary care. In today's post, PCP Colorado's chapter leader shares how his chapter used those skills to launch a student-run clinic in the medical school's local community.

By Joseph Johnson, M.D.

In 2013 at the Society of General Internal Medicine Conference in Denver, my primary care residency program director, Karen Chacko, arranged a meeting with Primary Care Progress to explore starting a chapter at the University of Colorado. I remember the thrill of reconnecting with an old high school friend, Trishul Siddharthan, now a PCP chapter leader and chief medical resident at Yale. He shared a powerful story of residents, medical students and nurses teaming up to advocate for increased primary care training opportunities made possible through the health system's acquisition of a major community provider network. Inspired by Trishul’s story, four of us – students and residents at the University of Colorado Anschutz Medical Campus – set to work that day to build a similar network that could fulfill our vision of collaboration between our campus and our forward-thinking neighboring community in Original Aurora.

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Posted by Sonya Collins on Aug 5, 2014 10:46 AM EDT
This public health manager turned family doc explains why students and residents in primary care must learn about billing and coding and what he is doing to help.

By Raymond Tsai, M.D.

For three years before I applied to medical school, I worked in post-Katrina New Orleans helping to rebuild school-based health centers. One of the main challenges, however, was how to create a sustainable safety net for at-risk youth to whom we were hoping to provide much needed health services – key word being “sustainable.” All too often, there isn't funding to carry out primary care’s mission of improving the health of communities and underserved populations. At the time, I was a public health manager, and I often felt frustrated at physicians who couldn't optimize their coding and billing. Not only were they leaving money on the table for the much-needed services they were providing, but they also made my job of trying to advocate for them near impossible. One of the avenues we tried to pursue was state funds to support the school-based health centers, but without proper coding, we never had accurate data to show exactly the needs we were addressing. In addition, when we asked state legislators for increased funding, we were easily countered with, "But you don't use the money we're giving you now through Medicaid..." The only thing I could do was stare back like a greedy kid who asks for seconds before I’ve finished what’s already on my plate.

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Posted by Sonya Collins on Jul 31, 2014 12:41 PM EDT
Many members of the PCP community recently attended the Direct Primary Care Summit in Arlington, VA. We'll be sharing their perspectives here over the coming weeks. Today a family medicine resident with a background in business makes "cents" of the model. 

By Sahil Jain, M.D.

“What is the value of the service I am providing you?” Dr. Brown used this question in a story that he told at the Direct Primary Care Summit in Washington, D.C., this June, about a $1,200 bill for a plumbing job that saved him a night’s sleep. It highlighted an important aspect of direct primary care that I have often been attracted to — creating value and capturing value.  Based on my knowledge from business school, it makes the most sense to me as a practice model in the outpatient medicine world.

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Posted by Sonya Collins on Jul 29, 2014 10:17 AM EDT
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Most Recent Comments

Great observations. I hope your self-care has sustained you through your last year of residency and beyond, and you...
My colleagues and supportive interprofessional team influenced my decision to stay. I appreciate having a psycho...
Wow. This is a really comprehensive guide to many of the issues and questions a practice and its leaders will need to a...
Kohar thanks for sharing your story. Preventing burnout and bringing back the joy in practice is such an important i...
Randi, thank you for sharing such a thoughtful and insightful piece. Even though I am not a clinician, I remember gra...

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