I remain very concerned about the use of the NCQA PCMH guidelines as the measuring stick for quality. There are numerous reasons as to why that particular measurement will not likely improve quality:
1) It is primarily focused on database infrastructure. Although this is
nice and helpful, adding a computer system to a dysfunctional practice
will lead to a dysfunctional practice with a computer system--not a
2) 60% of primary care docs are in 1-5 doc practices with little time or
money for IT development. They can and should be encouraged to provide
great primary care, but they cannot afford to buy the robust systems
necessary to do all the functions put forward in the PCMH guidelines.
Further, is it right to expect a practice to shell out $100,000 or more
for a new system with simply a promise of potential reimbursement later?
3) By having much of the system set up for database analysis and process
improvement, are we simply creating another industry we get to argue
with? Ex. How many docs like to do their own billing? How many do you
think will like to do their own database analysis? If we don't do it
ourselves, it becomes increased overhead and another potential wedge
between the doctor and the patient.
Some truths we do know--The system is broken. Quality medical care is
rare to find. Docs are not rewarded for quality care. Quality in primary
care is measured (by the patients--who know) as access, efficiency,
continuity, good information and coordination. Anything which distracts
us from focusing on these things is likely not going to help. We also
know that docs whose practices are focused on quality will not likely
improve much by going through this process and those who don't care
probably won't understand/care.
I believe the PCMH designation is something which is well intended. I
believe it has some good things associated with it. But, it will not improve the doctor-patient relationship in most offices and therefore is not likely to save money or primary care. We have to begin looking for the real answer.
Newport News, VA