A recent article published by EHR Intelligence explored the benefits, challenges, and strategies of non-physician-led patient-centered medical homes (PCMHs). Instead of the traditional approach of having a physician at the core of the PCMH care team, this emerging model recognizes the value and abilities of advanced care providers (ACPs) – namely, NPs and PAs – and puts them in a position to effectively lead the care team and operate the PCMH model.
The notion of a PCMH being led by someone other than a physician has received both support and scrutiny from providers and patients, and the debate has only intensified in light of The Joint Commission’s recent decision to accredit such entities. The American Medical Association (AMA) released a statement saying that “the ultimate responsibility of patient medical care rests with the physician and thus [the AMA] advocates that physicians maintain authority for patient care in any team-care arrangement to ensure patient safety and quality.” But in response to the EHR Intelligence article, one reader noted: “In many scenarios it is the PA or the NP who is actually taking care of the patient anyway.”
Imbuing ACPs with greater clinical and leadership responsibility is becoming increasingly necessary amid the realities of a resource-challenged healthcare industry. Given issues with physician shortages and workloads, many organizations simply may not be in a position to operate within a physician-led PCMH. Furthermore, in an environment characterized by growing patient demands and changing attitudes toward the deployment of ACPs, healthcare organizations are seeking innovative approaches to providing care while working within the licensure of the clinical resources available to them.
While such organizations may have to increasingly leverage ACPs, the PCMH model provides a structured means of providing care with standard work, policies, and procedures. This fixed set of standards and structured approach helps further ensure that the care delivered within a PCMH is consistent, regardless of the care team composition or leaders.
And while some may rightly question the safety and effectiveness of a PCMH led by anyone less qualified than a physician, it is important to remember that this model does not undermine existing oversight requirements dictated by physicians’ licensure. In fact, the PCMH model emphasizes team-based care and offers a more efficient vehicle for this oversight to function, providing a structure (i.e., daily huddles, care coordination, collaboration, and reports) that better allows the physician to fulfill these responsibilities.
The nation is looking to healthcare organizations to innovate and improve care delivery through better coordination and more efficient use of resources. The PCMH model, built on the fundamental concept of team-based care, is one solution. But as the model proliferates, healthcare organizations will have to be even more creative; and that may mean placing care team members, beyond just physicians, in leadership roles.