Solo practice endocrinologist Carol Greenlee is one of a small number of specialist physicians in the country who operate their practice as a patient-centered medical home, a model pioneered by primary-care doctors. She has expanded the medical home into a medical “neighborhood.”
From her office in Grand Junction, Colo., Greenlee studies patients' medical records and questions their other doctors so she is thoroughly familiar with their health issues before they arrive for visits. She also consults with other doctors electronically on difficult cases, which often makes it unnecessary for patients to come in for visits to her office.
But for now, she receives no additional payments from insurers for these patient-management services, despite having earned patient-centered specialty practice recognition this year from the National Committee for Quality Assurance. “We communicate back with the primary-care doctor after every one of our patients' visits,” Greenlee said. “But some of our patients might not use a primary-care doctor, so we have to look after them a little more.”
Greenlee hopes her NCQA recognition will inspire other small physician groups to transform their practices, and send a message to Medicare and private insurers that they should financially reward doctors for offering this higher level of service to patients.
Despite tensions between primary care and specialist groups over what types of practices should serve as medical homes, a growing number of specialist practices, insurers and health systems are moving toward the patient-centered specialty home model.