New Primary Care Models May Free Up Time for Patients

Patient-centered medical homes and nurse-managed health centers may help mitigate the expected shortage of primary care physicians, according to a new study.

Numerous forecasts have predicted shortages of primary care providers, particularly in light of an expected increase in patient demand resulting from the Affordable Care Act. Yet, these forecasts may not be accurate because they generally do not allow for changes in the way primary care is delivered.

“A few changes could help make a large dent in reducing physician shortages. For example, if payers continue to transition away from fee-for-service based mainly on visits with physicians and toward global payment models like accountable care organizations, this could incentivize primary care practices to use all the tools at their disposal to care for their patients effectively and efficiently,” David Auerbach, MS, PhD, Full Policy Researcher at the RAND Corporation, told ConsultantLive.

“Some of these tools involve transitioning to patient-centered medical home models, which appear to have greater numbers of allied health providers per physician, and increasing panel sizes by using technology, such as e-visits, kiosks, and retail clinics, to care for healthy patients with relatively simple problems. Essentially, moving payment away from being visit-based to being patient-based frees up the organization from maximizing physician visits to models that maximize patient health and satisfaction while minimizing resources used.”

Dr Auerbach and colleagues analyzed the impact of the patient-centered medical home and the nurse-managed health center, both of which use a provider mix that is richer in nurse practitioners and physician assistants than the currently predominant models of care delivery. They found that if medical homes expand to deliver nearly half of primary care, the nation’s expected physician shortage would fall by 25%. If nurse-managed health centers expand to account for 5% of primary care, the doctor shortage would fall by another 25%.

The researchers say those growth rates are plausible under the Affordable Care Act. The use of medical homes has been growing rapidly, and the Affordable Care Act provides up to $50 million to support nurse-managed health centers.

“As payment changes, practices may increasingly find these changes necessary,” said Dr Auerbach. “Many patients will welcome interacting with their providers more by phone, email, and computer when that is all that is needed, saving them time and money,” he noted. “Physicians are often more satisfied and happier when they are freed from the tyranny of squeezing in as many visits as possible, many of them possibly unnecessary-freeing them up to focus on the patients who need their time most. But the transition probably won’t be easy for everyone.”

Although the road may be rocky, the future of primary care is bright, Dr Auerbach said. “It’s an excellent time to be a primary care physician. Many of the changes in health care delivery and furthered by the Affordable Cart Act depend on a strong primary care foundation.”

Dr. Auerbach concluded, “Accountable, coordinated care, as opposed to ‘siloed,’ fragmented care, appears to be on the rise, and this requires more communication and relationships with other providers.”

The researchers published their results in the November 2013 issue of Health Affairs.