Cincinnati, Ohio, June 26, 2011
A spirited debate has been ongoing for a number of years about the roles of medical professionals in the patient-centered medical home (PCMH). While the conventional wisdom and current practice has had the lead role reserved for primary care physicians, other medical professionals, and especially advanced practice nurses, along with their advocacy groups, are increasingly challenging the status quo as they jockey for position and a more significant role in the medical home.
Although the patient-centered medical home concept has been around for some time, it has regained visibility since the implementation of the Affordable Care Act of 2010. Originally mandated by the Tax Relief and Health Care Act of 2006 and the Medical Homes Act of 2007, the PCMH is about understanding a patient’s needs, coordinating and providing evidence-based preventative, acute and chronic care through shared decision making between the patient and a multi-disciplinary team of providers.
Most of the medical home demonstration and pilot projects under way today are physician-led and most physicians, along with the four biggest physician advocacy organizations, prefer to keep it this way. While other medical professionals, such as nurse practitioners, pharmacists, social and case workers are certainly welcome to be part of the care team, the position of physicians is that PCMH’s should be physician directed and led.
In light of the significant shortage of primary care physicians expected in 15 years, the efforts by other medical professionals and especially nurse practitioners (NPs), advanced practice nurses and pharmacists, to secure more significant roles in PCMH’s appear to make good sense. Furthermore, with the contributions of NPs, advanced practice nurses, and pharmacists in the delivery of accessible, affordable, high quality and safe care well documented, the time might be right to give serious consideration to exploring expanded roles for them as primary care providers and leads in the PCMH model.
As a start, medical home demonstration projects should allow for nurse practitioner-, advanced practice nurse-, and perhaps pharmacist-led PCMH’s utilizing the same standards and scoring mechanisms applied to physician led PCMHs. The outcomes and results will speak for themselves. It is interesting to see progress in this direction being made at the state level, especially in states where nurse practitioners are already authorized to provide independent primary care. In addition, adjustments in the definition of medical homes as “clinician-,” rather than physician-led also open the door to this possibility.
For more information about the latest patient-centered medical home developments, please contact Bert Kollaard at 513-605-3633 or via email at
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