Safety-Net Clinics Adopt Medical Home Model

Proponents say certification ‘more than just paperwork,’ it’s a better model for practicing medicine

Elena Leal (left)


KANSAS CITY, Kan. – As an independent nonprofit focused solely on pediatrics, Turner House Children’s Clinic is unique among the state’s safety-net providers.

Now the practice claims another distinction: It’s one of five safety-net providers, out of approximately 40 around Kansas, to earn national recognition as a “patient-centered medical home” through the nonprofit National Committee for Quality Assurance (NCQA).

Health care reform advocates cite patient-centered medical homes as a best-practice in providing comprehensive primary care while reducing the need for costly treatments.

And the federal Department of Health and Human Services has set a goal of having 25 percent of the nation’s community health centers certified as medical homes in fiscal year 2013, which ends Sept. 30. With five of 40 clinics certified, Kansas is halfway to that goal.

Completing the NCQA application was onerous, said Janet Burton, executive director of Turner House, which handles about 9,000 visits a year on a roughly $2 million annual budget. But it was more than just paperwork, she said.

“We are adopting a new practice model,” Burton said, “and our goal was not just to do it and be recognized, but to say, ‘Yes, this indeed is our model. We are embracing this, and this is how we are going to move forward.’”

Steps included implementing an electronic medical records system, or EMR, and hiring a full-time pediatrician along with a pediatric nurse practitioner.

In a patient-centered medical home, caregivers assign each patient to a treatment team and group patient records by conditions (such as diabetes or asthma) to monitor and improve outcomes.

One national medical-home proponent is the American Academy of Family Physicians, based in Leawood. It contracts with practices nationwide to help them become patient-centered medical homes through its TransforMED subsidiary.

Medical Home Initiative
Turner House is a grantee of the REACH Healthcare Foundation in Merriam. Since 2007, REACH has granted approximately $1.1 million to seven safety-net providers through its Medical Home Initiative.

Three other REACH grantees are among the five safety-net clinics in Kansas to be certified as patient-centered medical homes by NCQA — Children’s Mercy West, Silver City Health Center, and the Health Partnership Clinic. (The fifth is Flint Hills Community Health Center in Emporia.)

However, achieving certification is not the ultimate goal of the initiative, said REACH Program Officer Dawn Downes. Some providers just don’t have the time or money to pursue certification, she said.

While not all of the initiative participants have achieved certification, Downes said, all have begun to improve patient care. For example, they have achieved no-show rates that are below the national average for community health centers and, in some cases, are below the 15 percent average for private practices.

After adding a ninth exam room, Turner House reduced the wait for a well-child visit about two weeks. It used to be about 45 days.

Turner House is also using its electronic medical record system to store the education level of parents, many of whom are low-income Hispanics. Burton said physicians are more deliberate in giving instructions to parents who are less proficient in English.

For example, she said, “if you prescribe an antibiotic for a child to a family with a low literacy level, you really have to make sure you take the extra time to talk about how that antibiotic is to be used and make sure they understand that.”

She also said physicians routinely tell her stories about how the emphasis on continuity of care – with doctors seeing the same patients each time – has improved their effectiveness. One doctor recently diagnosed a newborn with E. coli after noticing that the infant didn’t seem to be acting as it usually did.

Turner House has also increased its Medicaid revenue by getting more of its patients into the program and also by increasing its number of patient visits by about 25 percent in the last two years. Overall revenue is up about 25 percent from two years ago, Burton said.

Cathy Harding — executive director of the Kansas Association for the Medically Underserved — said it makes sense for clinics to move in the direction of medical homes, particularly since certification might be a key component in insurance reimbursements down the road.

“We kind of anticipate that at some point in the future that will come into play,” she said.



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