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Mr. Roger’s “Medical Home” Neighborhood

My image of Pittsburgh has been one of a blue-collar, rough-and-tumble town: Perogies, Heinz ketchup, steelworkers, football, and Roberto Clemente. But an exhibit in Pittsburgh’s airport the other day informed me that Pittsburgh also is the home of the iconic “Mr. Roger’s Neighborhood” — the gentle PBS show that entertained toddlers for generations. Mr. Rogers always started the show off with the following verse:

It’s a beautiful day in this neighborhood,
A beautiful day for a neighbor,
Would you be mine?
Could you be mine?

It’s a neighborly day in this beautywood,
A neighborly day for a beauty,
Would you be mine?
Could you be mine?

I have always wanted to have a neighbor just like you,
I’ve always wanted to live in a neighborhood with you.

So let’s make the most of this beautiful day,
Since we’re together, we might as well say,
Would you be mine?
Could you be mine?
Won’t you be my neighbor?

Won’t you please,
Won’t you please,
Please won’t you be my neighbor?

Fittingly, the same week that I was reminded of “Mr. Roger’s Neighborhood,” the American College of Physicians (ACP) released its “medical home neighborhood” position paper. The paper was developed by a workgroup of ACP’s Council of Subspecialty Societies (CSS), which is comprised of representatives of internal medicine subspecialty societies and related organizations.

The paper proposes ways that internal medicine subspecialty practices can be recognized as Patient-Centered Medical Home Neighbors (PCMH-Ns). A specialty/subspecialty practice recognized as a PCMH-N engages in processes that:

— Ensures effective communication, coordination, and integration with PCMH practices in a bidirectional manner to provide high-quality and efficient care;

— Ensures appropriate and timely consultations and referrals that complement the aims of the PCMH practice;

— Ensures the efficient, appropriate, and effective flow of necessary patient and care information;

— Effectively guides determination of responsibility in co-management situations;

— Supports patient-centered care, enhanced care access, and high levels of care quality and safety; and

— Supports the PCMH practice as the provider of whole-person primary care to the patient and as having overall responsibility for ensuring the coordination and integration of the care provided by all involved physicians and other health care professionals.

The paper proposes a set of “aspirational principles” for developing “care coordination agreements” between the PCMH-N and the PCMH to “define the types of referral, consultation, and co-management arrangements available.” ACP also proposes that incentives be aligned to support PCMH-Ns, including “some form of enhanced payment to cover the time and infrastructure costs of providing services consistent with the PCMH-N definition.”

I think that the PCMH-N concept is critical to building a health care system that supports the value of primary care provided in a PCMH, but also recognizes that the model cannot work without the engagement of specialists in working together with the medical home to deliver the best care possible. It belies the notion that the PCMH is only for primary care physicians, or that ACP is uninterested in helping its subspecialist members.

If the paper’s vision is realized, subspecialists should be able to give a resounding “yes” when asked by a primary care physician: “Won’t you please, Won’t you please, Please won’t you be my neighbor?”

Today’s question: What do you think of the Patient-Centered Medical Home concept as proposed by ACP’s Council of Subspecialty Societies?

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

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