Proposal would put patients first

Imagine arriving at your primary care physician's office and instead of waiting 30 minutes for a short visit about a complex medical problem, you get an hour of the doctor's time, specific care recommendations and long-term follow-up by e-mail.

Such a scenario would become the norm, in theory, under a health-care reform proposal laid out for a standing-room-only crowd at the University of Utah on Thursday. Dubbed "the patient-centered medical home," the concept puts the patient's concerns at the center of the system and relies heavily on expanded services offered by a team of providers working with the primary care physician.

Dr. Tom Bodenheimer, professor of family and community medicine at the University of California San Francisco, said the most patient-friendly feature of the proposed system would allow those seeking an immediate appointment to get one on the same day with their own doctor, rather than waiting for an opening or seeing another provider.

The potential downside for patients is that, unless they have a major medical problem, they may not be seen by their primary care doctor, but by other medical team members with whom they have yet to develop a trusting relationship.

One of the main features of the proposal is changing the way health-care providers are paid, he said. "We've got to stop incentivizing quantity," where primary care doctors see as many patients as they can squeeze into a day in order to maximize profits. Rather than the current "fee for service" payment plan, insurers would reward health-care providers that actually improve patient health, rather than simply continue to provide service that "has no value," he said.

An emphasis on patient responsibility would be enhanced through the primary care team, Bodenheimer said, comprised of nurse practitioners, medical assistants, nurses and other professionals, depending on the size of the practice. Most patients would receive expanded medical services from team members, allowing the doctor to spend more time with those whose critical medical needs can only be met by a physician.

As part of the patient-centered nature of the proposal, team members would help educate patients regarding preventive health care to help them avoid preventable medical conditions, follow-up to make sure patients are taking their medications, and communicate by e-mail to answer patient questions.