Tuesday, February 28, 2012

Too Many Docs in the Kitchen? Careful Redundancy or Unnecessary Overcomplication?

I have just had the privilege of sitting in on a Patient Centered Medical Home meeting for the family medicine practice with which I am currently rotating. As I sat around with 16 health providers over the course of a 90 minute conference, two conflicting thoughts struck me:

1) Isn't it GREAT that we are able to have this coalescence for the good of patient care?
2) Is it really beneficial to have all these people in on the conversation?

I quickly did the rough mental math on 16 providers spending 90 minutes in a conference. It is certainly costly, and it additionally takes away from what could be a full 24 hours of one-on-one patient care.

The goal of this particular meeting was to analyze and discuss patients that are on the high end of the cost curve - those that are outliers in terms of readmission rates, ER visits, and other concerns of overutilization. From a cost-reduction and care standpoint, this was likely a productive meeting. Less than a dozen patients were targeted and discussed over the course of the 90 minute session. For those patients, the value for the extra time and concern for there care is immeasurable.

Simultaneously, I believe there was another current at work here - the adherence to the vision of the team-oriented approach in the Medical Home model. Bringing these providers together in one room allowed for a team-oriented discussion. However, at the same time, I witnessed a majority of bored faces, yawns, and disinterest. One person spoke at a time and, it seemed, the rest were more or less varyingly engaged.

Yet the box was checked. The meeting was held. But was the value and vision of the PCMH met?

Bringing 16 providers into a room sounds great. Then, why not make it 20, or 30, or 50 at a time? At what point do we sacrifice the general good of overarching patient care, to take the time to "check the box".

These are just some thoughts that crept through my mind over the course of this afternoon. My only intention in my criticism is in the opportunity for self-reflection and advancement. Ultimately, I am certain this model is far superior to the isolated islands of care of yesteryear, most prominently for the dozen or so patients discussed.

Are we truly moving forward or are we just taking baby steps while posturing?