Top Doctors 2009: The Doctor Is In

A new medical model sounds like a throwback to earlier times when family physicians actually had tim

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The idea alone horrified Group Health family doctor Harry Shriver: Answer his own phone—without a nurse screening calls first? Give patients his email address?

It’s not that Shriver considers himself too important for such mundane tasks. It’s just that from the moment he walked into the Factoria Medical Center clinic every morning until he left, he literally went from exam room to exam room the entire day almost without stopping. Typically he’d see as many as 22 patients a day, with problems from the simple—a case of the flu—to the complex—an elderly person with both diabetes and heart disease. When he wasn’t with patients, he was working his way through paperwork or wading through administrative details. Each day was, quite simply, grueling, and Shriver began thinking more and more about retirement.

Today, Shriver sees half as many patients in a day, and spends up to 30 minutes with each. That gives him time to really communicate with patients, to sort through health concerns, physical and emotional. He picks up the phone when his patients call, and he answers their emails.

He’s never been happier in his 35 years of practice—and he believes his patients have never been healthier. Emergency room visits are down for his patients and those of his fellow physicians at the Factoria clinic. Patients are following medical orders better and are more successfully managing chronic conditions. And Shriver, 65, has put off thoughts of retirement. “I’m having too much fun,” he says.

It’s all part of a relatively new approach to health care known as the “medical home” model, and for supporters, it holds the key to reforming the nation’s health care at a time when chronic diseases like diabetes are rising to epidemic levels, baby boomer health needs are skyrocketing and overall medical costs continue to spiral ever upward. It’s an approach also being pioneered in the Swedish Medical Center system. And it’s a version of a model that’s gaining attention around the nation.

Simply put, the medical home concept turns the current model of primary care—mostly provided by internists, family practice doctors and pediatricians—on its head. At present, the vast majority of primary care doctors are reimbursed per procedure or number of patients seen—not for how healthy they keep their patients. That means primary care doctors, who already receive some of the lowest reimbursements of any physicians, work long days stuffed full with patients, and are able to spend perhaps only seven to 10 minutes a visit with each person they see. Often, they’re double-booked: Two patients are in separate exam rooms with the same appointment time. Because they don’t get paid for it and they’re already burdened with paperwork, it’s difficult for primary care doctors to spend much time on the phone with patients, or to answer email.

In the medical home model, doctors are reimbursed, often on a monthly basis, for seeing fewer patients—in order to keep them healthier. (Group Health, however, as a member-only system, has a slightly different model, with most care provided through its network of doctors and facilities.) Savings for all medical home models come from several factors, including fewer hospitalizations and fewer costly visits to the emergency room; both of these decreases occur because patients are tracked more carefully. Also, more doctor-patient interactions occur—and more quickly—via phone calls or secure email, cutting down on the expense of office visits.

“The patients love it,” says Alicia Eng, the clinic operations manager for the Group Health Factoria Medical Center. Eng, who is a registered nurse with an MBA and a master’s degree in health administrat

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