The following has been adapted from a presentation by Donald A. Balasa, JD, MBA, addressed to the House of Delegates of the American Association of Medical Assistants at the 2009 AAMA Annual Conference.
A foundational document for defining the Patient-Centered Medical Home (PCMH) is Joint Principles of the Patient-Centered Medical Home (Joint Principles), issued by the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP), and the American Osteopathic Association (AOA), published by the Patient-Centered Primary Care Collaborative (PCPCC).1 What follows is a summary of the PCMH movement, with important parts of Joint Principles paraphrased.
Defining elements of the PCMH
The PCMH is a revolutionary approach to health care, incorporating these four important elements:
1. The team approach. A key theme of Joint Principles is the team approach, which may be defined as follows:
The physician leads a team of individuals who “collectively take responsibility for the ongoing care of patients.”1
Physicians will oversee and direct the provision of health care in a PCMH setting. However, other health professionals—CMAs (AAMA), physician assistants, nurse practitioners, physical therapists, registered nurses—will be expected to work together with the physicians to provide care that is coordinated and sensitive to the needs of the patient. Thus, collective responsibility for the health and well-being of patients is one of the distinguishing features of the PCMH.
2. Whole person orientation. A second distinctive element of the PCMH is whole person orientation, which may be summarized as follows:
All the patient’s health care needs are provided for in the primary care setting, including arranging care with other qualified professionals and providing for all stages of life (i.e., acute care, chronic care, preventive services, and end-of-life care).1
In a PCMH setting, health team members must be able to communicate effectively, and must be careful listeners. All team members empathetically listen to patients and meaningfully communicate so that the patient (and the patient’s representatives) understands. Studies have shown that one of the primary reasons health outcomes are not as good as they should be is because patients do not understand what the physician is telling them. By employing enhanced communication skills, the PCMH greatly reduces instances of patients not comprehending the diagnosis and the treatment.
3. Patient advocacy. A third hallmark of the PCMH is patient advocacy, which can be defined in this way:
Team members advocate for their patients so they receive optimal care in all settings.
For the best possible care, patients should have someone who is overseeing and coordinating their care in all areas of the complex and multifaceted health system. CMAs (AAMA) are ideal professionals for this important responsibility because of their education, credentialing, and continuing competence and knowledge.
4. Enhanced access to care. Fourthly, the PCMH is characterized by enhanced access to care. Employing language from Joint Principles, the following definition can be offered:
“Open scheduling, expanded hours, and new options for communication” are implemented as appropriate.1
Because CMAs (AAMA) are often the first point of patient contact, including providing scheduling services, they are integral players in the movement to enhance access to care.
The PCMH initiative has fueled an increasing awareness of medical assisting and CMAs (AAMA), which has brought long-term potential opportunity for medical assisting, including many tangible benefits.
The medical assisting profession is well known within PCMH centers of power. For example, at every PCMH meeting I have attended—including the annual Conference on Practice Improvement sponsored by the American Academy of Family Physicians—I was pleasantly surprised to find that everyone knew about the medical assisting profession, and many knew about CMAs (AAMA). For over 20 years, one of the greatest frustrations I have experienced during national medical meetings was that people who should have known better frequently confused medical assistants with physician assistants, nursing assistants, and other personnel.
To be honest, I cannot say that everyone at these PCMH meetings knew the difference between CMAs (AAMA) and other medical assistants. We can work on this. The PCMH arena provides an environment in which decision makers already know who medical assistants are. We can build on this reality to promote the advantages of hiring a CMA (AAMA) to work
in a PCMH.
Stronghold for partnerships
The AAMA has garnered increased visibility through partnerships with leading organizations in the PCMH movement.
Primary care specialty societies. Three of the most prominent primary care specialty societies—the AAP, the ACP, and the AAFP—have written letters of appreciation for the joint projects they and the AAMA have begun. These letters are on the AAMA website at http://aama-ntl.org/resources/library/PCMH_letters.pdf, and I would urge all of you to read them.
The PCPCC connection. The AAMA has become a member of the PCPCC, the advocacy arm of the PCMH movement. Note the following description of the PCPCC:
The Patient-Centered Primary Care Collaborative is a coalition of major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, clinicians, and many others who have joined to develop and advance the Patient-Centered Medical Home. The Collaborative has well over 500 members.2
The PCPCC has close contact with federal legislators and agencies, and is striving to ensure that the primary care dimension of health care is not neglected in health reform legislation and other federal programs. There are semiannual meetings in Washington, D.C., and monthly teleconferences to keep members apprised of the progress of legislation in Congress. I have attended two Washington, D.C., meetings of the PCPCC, and have participated in several conference calls.
Publication with AAP. I was asked to write a piece for Practice Management Online—the practice management section of the website of the AAP. My article, “The CMA (AAMA): An Invaluable Asset for the Pediatric Office,” was published in June 2009. The AAP continues to be very supportive of the CMA (AAMA) and the AAMA.
ACP and AAFP links. Both the ACP and the AAFP have posted links on their websites to the AAMA website—specifically to the Key State Scope of Practice Laws section.3 As a result, more physicians have become aware of what duties they can delegate to medical assistants, and I have received an increasing number of scope-of-practice questions via e-mail and telephone.
A great many steps forward in the legal arena have been taken as a result of the PCMH movement.
Identity for the profession. The PCMH groundswell has forged a platform for medical assistants to obtain a legal identity. Currently, the two-word phrase “medical assistant” appears in the statutes or regulations of only seven of the 50 states. This fact results in lack of legal identity, or legal existence, in many states. However, because of the heightened awareness of medical assistants within the PCMH movement, legislation and regulations are more likely to include specific references to “medical assistant” and “medical assisting.”
Differentiation for the credential. The PCMH will result in legal differentiation of the CMA (AAMA). CMAs (AAMA) are already being expected to undertake more advanced duties, and a greater breadth of duties, within the PCMH environment. In recent months I have received a greater number of scope-of-practice questions about limited scope radio-graphy, telephone screening (following physician-approved protocols, algorithms, or decision trees), and administration of influenza vaccines, for example. This demand for expanded duties for CMAs (AAMA) provides opportunities for differentiation between the legal scope of practice for CMAs (AAMA), and the scope for all other medical assistants.
Health reform legislation. As we all know, President Obama’s health reform proposals are meeting with opposition from both the political left and the political right. Regardless of one’s opinions about health reform, it is noteworthy that all current health reform bills make specific mention of the PCMH model of delivering primary care. Obviously, this provides a golden opportunity for us!
Spreading the word
The AAMA is getting the message across to key decision makers that CMAs (AAMA) are ideal professional partners in all types of team-based care, including the PCMH. Please join me in spreading the word about the vital role of CMAs (AAMA) in the PCMH!
Questions? Contact Donald A. Balasa, JD, MBA, at email@example.com or 800/228-2262.