ANN ARBOR, Mich. — Primary care practices have traditionally been thought of as being the most logical “medical home” capable of managing and coordinating care for patients with chronic conditions.
However, there are certain chronic conditions for which urology practices are well-suited, and in some cases, better equipped, to carry out medical home functions compared to their primary care counterparts, according to a new study led by researchers from the University of Michigan.
The study, published online in The Journal of Urology, revealed that nearly three-quarters of urology practices meet national standards to qualify as a medical home.
“The medical home model has been widely discussed in the context of primary care while relatively little attention has been directed towards specialty care,” says Joe Sakshaug, Ph.D., the lead author of the study, formerly a doctoral student in the Program in Survey Methodology at the University of Michigan’s Institute for Social Research, and now Alexander von Humboldt postdoctoral research fellow in statistics at the German Institute for Employment Research and the Ludwig Maximilian University of Munich.
“For some chronic urologic conditions, including prostate cancer and other genitourinary cancers, urology practices may serve as more logical medical homes for patients requiring ongoing care.”
The study authors used data from the National Ambulatory Medical Care Survey – a nationally representative sample of outpatient visits to office-based physicians – to map physician practice characteristics collected from the survey to the National Committee on Quality Assurance’s (NCQA) Patient-Centered Medical Home standards, the most commonly used medical home recognition process in the U.S. The mapped NCQA elements were then used to measure the “structural readiness” of a practice to become a medical home.
The investigators found that on average urology practices scored higher than primary care practices on medical home readiness and achieved a higher percentage of “muss pass” elements that are required for medical home recognition. Urology practices generally performed better than primary care practices on the use of electronic systems for tracking patients and test results.
The researchers further assessed the feasibility of transferring care for primary care patients with genitourinary (GU) cancers, including prostate, bladder, kidney, and testicular cancers, to urologists. By calculating the total time spent by primary care physicians in direct and indirect care for GU cancer patients, they found that reallocating half of this care alone would result in less than four additional work days per year for every practicing urologist, or the equivalent of expanding the urology workforce by 89 physicians.
While this consolidation of care seems feasible and reforms are already in place to provide incentives for practices to increase their medical home capacity, the authors caution that it would require proficiency and willingness on the part of urologists to manage and coordinate care for a host of non-urological conditions outside of their traditional scope of practice.
“Unfortunately the NCQA standards do not evaluate a physician’s ability to function as a physician in a medical home,” says Sakshaug. “As this reform becomes more widespread, there undoubtedly will be more specific credentialing requirements put in place.”
Sakshaug and his coauthors encourage policy-makers and healthcare professionals to develop “pilot initiatives and/or ‘proof-of-concept’ demonstration projects to assess the viability of specialist practices as medical homes.”
“We hope that our study advances the notion that specialty practices are capable of playing a more prominent role in the medical home discussion, but ultimately the decision of whether or not to participate in this innovative healthcare delivery reform should be decided jointly by the individual physician and their patients,” says Sakshaug.
Additional authors: David C. Miller, MD, MPH; Brent K. Hollenbeck, MD, MS; John T. Wei, MD; and John M. Hollingsworth, MD, MS; of University of Michigan Health System, Department of Urology.
Funding: The study was partially supported by the Alexander von Humboldt Foundation.
Citation: Sakshaug, JW, Miller, DC, Hollenbeck, BK, Wei, JT, Hollingsworth, JM. “Urologists and the Patient-Centered Medical Home” The Journal of Urology (2013), published online ahead of print
About the Institute for Social Research
Established in 1949, the University of Michigan Institute for Social Research is the world's largest academic social science survey and research organization, and a world leader in developing and applying social science methodology, and in educating researchers and students from around the world. ISR conducts some of the most widely cited studies in the nation, including the Thomson Reuters/University of Michigan Surveys of Consumers, the American National Election Studies, the Monitoring the Future Study, the Panel Study of Income Dynamics, the Health and Retirement Study, the Columbia County Longitudinal Study and the National Survey of Black Americans. ISR researchers also collaborate with social scientists in more than 60 nations on the World Values Surveys and other projects, and the institute has established formal ties with universities in Poland, China and South Africa. ISR is also home to the Inter-University Consortium for Political and Social Research, the world's largest digital social science data archive. For more information, visit the ISR website at www.isr.umich.edu