Patient-Centered Medical Homes and Nurse Practitioners: A Perfect Match?

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Patient-centered medical homes are a relatively new concept in the healthcare field. After all, the National Committee for Quality Assurance only began recognizing clinics as patient-centered medical homes in 2008.

However, the notion of PCMHs being a "change" in healthcare is not entirely accurate, according to Sean Lyon, MS, APRN, project director of Life Long Care, a PCMH in New London, N.H. "We joke about patient-centered medical homes being 'nursing 101,'" he says.
Sean Lyon
Life Long Care has no physicians; instead, it is made up of four nurse practitioners, a registered nurse, a medical assistant and an office manager and support staff.

Mr. Lyon's PCMH was the first nurse practitioner practice in the nation to reach the highest level of certification, level three, from NCQA with a score of 93 out of a possible 100 in 2009.

Here, Mr. Lyon discusses the benefits and drawbacks of running a patient-centered medical home as a nurse practitioner.

PCMHs and nursing 101

In many ways, the goals and practices of patient-centered medical homes align very well with what nurses are taught during their education. Therefore, having a nurse practitioner-led PCMH makes a lot of sense.

"The vast majority of care in a medical home model is basic care," says Mr. Lyon. Healthcare systems often leave follow-up calls and care coordination to nurses to begin with, so doing those tasks in a PCMH model is no different. "That has been part of our training and the basics of what we have done for years," he explains.

Part of the philosophy of patient-centered medical homes, as the name implies, is putting the patient's health first. "The nursing model is one of working on a holistic approach and working on where the [patient] is in the balance of their life," Mr. Lyon says. "It is by definition patient-centric." In that way, nurse practitioner training aligns perfectly with the goals of patient-centered medical homes.

Nurse practitioner roadblocks

Even though patient-centered medical homes highlight a lot of the strengths that nurse practitioners possess, there are not many PCMHs led solely by nurse practitioners across the country, in part because of certain limitations they face from the state and federal government.

For instance, many states do not allow nurse practitioners to prescribe or diagnose without physician involvement.  In fact, 32 states require a degree of physician involvement for NPs to diagnose and treat or prescribe medication, or both, according to a brief in Health Affairs. On the other hand, nurse practitioners in New Hampshire, 17 other states and the District of Columbia can diagnose, treat and prescribe medications for patients with no physician involvement. "There are some clinics [in Pennsylvania] spending money having a physician signing off for them," says Mr. Lyon. "That just blows me away."

Another roadblock to PCMH formation for nurse practitioners involves eligibility for the federal stimulus for electronic health records. Life Long Care serves enough Medicare patients to be eligible for federal funding for EHR systems, but, in the section of law that created this funding, CMS was limited to defining eligible  'care providers' as MDs and DOs, meaning nurse practitioner-led clinics with no physician present could not receive money from the stimulus.

Luckily for Life Long Care, the clinic has had EHRs since it opened in 2003, but CMS' definition could hold back other nurse practitioner-led clinics that need EHRs to start the journey of becoming a patient-centered medical home. "The definition of 'healthcare provider' could be changed," says Mr. Lyon.

Even though Mr. Lyon advocates for other states to align nurse practitioners' practice law with the scope of care they are equipped to provide, he says his concern is not just for his NP colleagues. "It's the patient who ends up suffering in terms of cost and quality of care," he says. And after all, patients are what PCMHs are all about.

More Articles on Patient-Centered Medical Homes:

Mercy's Journey Toward Patient-Centered Medical Homes, Population Health
4 Tips for Patient-Centered Medical Home Recognition
How the Patient-Centered Medical Home Model is Improving Patient Experience at Rural Yuma District Hospital

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