The Achilles Heel of the Medical Home

This is the second in a series of communications on productivity and its impact on our individual futures and the future of health care. Last time we discussed why “productivity” has a negative connotation. Now, we’ll examine the direct relationship between low productivity and the success of the medical home model, with the next post focusing on the barriers to greater productivity. Finally, we’ll see what improved productivity looks like in the exam room.

Why aren’t medical home results more uniformly positive?

Just so we are clear, the evidence gathered after a decade of medical home operation is promising, especially in terms of chronic care management, mortality, decreased ED visits and hospital admissions. At the same time, it remains insufficient and at times, equivocal. For me, the medical home, though it didn’t have a formalized name yet, is the reason I became a primary care physician. So why, after so much investment and effort, aren’t practices that are certified medical homes experiencing more dramatic improvements?  Well, here are five factors that are holding us back and all of them are related to reduced productivity.

5 Reasons Why Low Productivity is Slowing Us Down

1. Low access for a high number of people

Low productivity and reduced access to a medical home go hand in hand – and by low, I mean 14-18 patients a day. Timely, appropriate access both for the acute and chronic needs of a provider’s panel is a requisite for any effective medical home. Lack of needed access is especially critical since it impacts so many patients. In 2015, over 35 percent of primary care visits were not seen in primary care practices. That means a large segment of the population couldn’t access the benefits they could otherwise receive from a medical home.

2. A negative impact on quality

With more than a quarter of all appropriate primary care office visits currently going to Urgent Care Centers and Retail Clinics due to access and convenience issues, quality is being thwarted. The fragmented, limited care of UCCs and RCs cannot produce the same outcomes as continuous, coordinated and comprehensive care, and the literature is replete with studies showing that an on-going relationship with the same care team yields increased longevity and healthier lives, along with lower costs. 

3. Decreased patient engagement

Access when and where it’s needed is a strong determinant of trust, and relationships built on trust are much more motivational and collaborative. When rapid access is limited because productivity is low, patients are far more likely to seek care in settings where the lack of a relationship impacts everything from compliance to personal accountability and patient satisfaction.

4. Inadequate finances and staffing

The downward spiral continues into financial issues, with a focus on the leakage of acute care visits – often the most patient-pleasing and profitable of the day. Losing this income source due to low productivity/reduced access undermines the financial viability of medical homes. High productivity also creates the only reliable, long-term source of capital to supply the staffing requirements of a high-performing medical home as well as the revenue streams needed to assure acquisition of needed technology.  

5. Increased risk of burnout

A wide scope of studies indicates that chronic work disruption caused by providers doing non-provider activities, and the productivity loss that results, are prime factors in clinician burnout – with the corollary that providers are most fulfilled when they can focus on patients. PCPs in medical homes are spending more than 60% of their time doing non-provider work. Having more staff with the right skills can go a long way toward reducing or eliminating this aspect of burnout. And once again, low productivity and its companion, low efficiency, are the culprits. 

Join us in the next post when we’ll look at the barriers that many providers face on the path to higher productivity.