medical homes

The President’s Podium: Primary Care Competition

Posted in Accountable Care Organizations, Health, Health Policy, Health Reform, medical homes, Primary Care, Retail Clinics on October 15th, 2013 by MMS Communications – 1 Comment

by Ronald Dunlap, M.D., President, Massachusetts Medical Society DSC_0003 Dunlap 4x6 color 300 ppi_edited

The shortage of primary care physicians, besides creating longer wait times for both new and existing patients, is also changing how care is being delivered.

National pharmacy chains are seeking bigger roles in patient care, like managing chronic diseases, and they’re developing partnerships with medical groups large and small across the country.

Non-physician health professionals are also pressing for more opportunities. Nurse practitioners, for example, encouraged by a 2010 Institute of Medicine report, are engaged in advocacy and legislative efforts to establish independent practice, unburdened by physician supervision. Chapter 224 of Massachusetts General Laws, passed last year, included a new definition of primary care and expanded authority for NPs to sign documents once limited to physicians. This has given some NPs the impetus to set up independent practice.

What effects will these efforts have on primary care? Let’s take a closer look.

Retail clinics:  How often and for what purposes patients will visit retail clinics remain open questions, as these clinics are just now expanding their services from basic offerings to more complex endeavors such as lab services and managing chronic diseases. Unlike many other states, Massachusetts health officials have established a long list of regulations that these limited service clinics must follow.  However, Chapter 224 also requires the Department of Public Health to promote these clinics to the full extent of the scope of practice of NPs (who generally run these operations), but not to classify the clinics as primary care providers.

Research shows that patients like the convenience of retail clinics, particularly when they have difficulty getting to their primary care provider. Given the limited resources and no onsite physicians, most patients may not regard them, at least for now, as a place for primary care. As they add more sites, services, alliances, and advertising, however, they are likely to play a bigger role in health care – a prediction already being made by health care analysts.

Nurse practitioners: NPs play a vital role in health care. They always have, and they will play an even larger role as the team approach to care becomes more prevalent with medical homes and accountable care organizations.

The idea, however, that independent practice by NPs can fill the physician gap falls short. For one, a nursing shortage exists alongside the physician shortage, and nurses, like physicians, are an aging part of the healthcare workforce, with more than half of nurses approaching retirement.  The difficulty in recruiting nursing school faculty to teach a new generation adds to the problem.

Independent practice by NPs isn’t likely to increase the number of primary care providers; at best it might redistribute some to underserved areas. Most now work in urban areas, as physicians do, and most hospitals will not allow NPs on staff without physician supervision.

Further, with an emphasis on cost containment, replacing high-salaried providers (physicians) with lower ones (NPs) with less training will likely not result in savings. We have seen that less-experienced providers tend to order more tests and procedures, raising costs. Cost control will result best from the team approach of coordinating care and avoiding unnecessary referrals, testing, and procedures.

Finally, as independent or solo practice by physicians is becoming less and less viable with the growth of medical homes and accountable care organizations, the same is likely to happen with nurse practitioners.

While retail clinics and independent practices may have their place, continuity and coordination of care is much preferred over fragmented care from multiple providers. I believe the basis of good health care remains within the physician-patient relationship, supported by nurse practitioners, physician assistants, and other allied health professionals in a team approach. Patients will benefit most from this kind of an approach.

The President’s Podium appears regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine.



September Physician Focus: The Physician-Patient Relationship

Posted in Health, Health Reform, medical homes, Medicine, Physician Focus, Primary Care on August 30th, 2013 by MMS Communications – Comments Off on September Physician Focus: The Physician-Patient Relationship

Since the days of Hippocrates, the physician-patient relationship has been regarded as the foundation of good health care, thus making the selection of a physician one of the most important medical decisions a patient will make.

The September episode of Physician Focus provides an in-depth discussion of this key element of health care with two experienced primary care physicians.

Special guest for this program is MMS Vice President Dennis M. Dimitri, M.D., a board-certified family physician in Worcester, Mass. with more than three decades of primary care experience.

Dr. Dimitri, (photo, seated) Clinical Associate Professor and Vice Chair of the Department of Family Medicine and Community Health at UMass Memorial Medical Center and UMass Medical School in Worcester, joins fellow family physician and program host Mavis Jaworski, M.D. for the conversation.

Focusing on primary care, the physicians examine a range of topics, including what factors patients should consider when seeking a physician, the elements that make up a good physician-patient relationship, the barriers that might negatively affect the relationship, what patients and physicians might do if the relationship doesn’t seem to be working, and the potential impact on the relationship of new models of care such as the patient-centered medical home and accountable care organizations.

Physician Focus is available for viewing on public access television stations throughout Massachusetts and also available online at ,  and on iTunes at

Annual Education Program: How Technology Is Improving Patient Care

Posted in Electronic health records, Health IT, medical homes on May 10th, 2013 by MMS Communications – Comments Off on Annual Education Program: How Technology Is Improving Patient Care

From electronic health records to medical devices to the latest in research, technology is continuing to push into new frontiers in medicine, and that bodes well for patient care.

In introducing the 2013 Annual Education Program, Navigating the Currents of Change: Integrating Innovative Technologies Into Your Clinical Practice, MMS President Richard Aghababian, M.D. said “Incorporating technology into our approaches to patient care is one of the biggest challenges we face as physicians today. The tools and data we now have at our disposal are truly amazing. But we must balance the machines with the humans side of medicine.”

The educational program on Friday, May 10 included four distinguished clinicians and scientists who addressed concrete examples of how the latest technologies have made advances in the surveillance, diagnosis and management of disease, and how those technologies are being incorporated into patient care.

Dr. Robert L. Jesse, Principal Under Secretary of Health at the Department of Veterans Administration, discussed health information technology and how it affects patient care.

Dr. Marc Semigran, Medical Director of the Massachusetts General Hospital Heart Failure and Cardiac Transplant Program, talked about how technology and the latest medical devices are improving and extending the lives of patients with heart disease.

Dr. Suzanne  Topalian, Professor of Surgery and Oncology at Johns Hopkins School of Medicine, examined how nanotechnology and targeted immunotherapy are making progress in the battle against various forms of cancer.

Dr. John Moore, of MIT’s Media Lab, discussed the application of technology for patient empowerment within the medical home model.

The participants’ presentations, along with their biographical information, are available for viewing here.


April Physician Focus: Checkups and Screenings: What Do You Need?

Posted in Health, Health Policy, Health Reform, medical homes, Medicine, Physician Focus, Primary Care on April 1st, 2013 by MMS Communications – 1 Comment

The annual physical exam and other periodic screenings have for years been considered key elements to sound medical health, offering prevention against disease and illness. Yet recent studies have called into question the value of these exams, saying such testing has had no effect on reducing disease or death and in some cases causes harm.

The April episode of Physician Focus, Checkups and Screenings: What do you need?, offers an in-depth discussion of this issue with Michael Barry, M.D., president of the Informed Medical Decisions Foundation in Boston and medical director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital. Hosting the show is primary care physician Mavis Jaworski, M.D.

Among the topics of conversation are the pros and cons of medical tests and treatments, how to decide which ones to have, why patients should have a greater voice in their health care decisions, and the concept of shared decision-making – physicians and patients working together so that, in Dr. Barry’s words, “good medical decisions are made with the full participation of an informed patient.”

Physician Focus is available for viewing on public access television stations throughout Massachusetts and also available online at and on iTunes at


Mass. Medical Home Project is About to Begin: Apply Now

Posted in medical homes, Primary Care on July 16th, 2010 by MMS – Comments Off on Mass. Medical Home Project is About to Begin: Apply Now

380892395_1046c983a0_bThe Commonwealth of Massachusetts is about to start a project that could transform the practice of primary care medicine, if it’s successful.

This week the state announced that it’s accepting applications for its three-year Patient Centered Medical Home Initiative. The project will test the proposition that medical homes can improve quality and efficiency, and perhaps even save the primary care practice.

The deadline to apply is August 12, 2010.

The program includes some financial support, lots of training, and the assistance of a facilitator to help practices as they go along.

Unfortunately, applying is not a simple process. The application is funneled through the state’s public procurement system, which automatically brings into play a lot of arcane state laws and regulations. The application itself is 39 pages long. That’s why the state is holding two webinars next week to help practices through the process.

But given its promise for making a difference in primary care medicine, we think it’s worth the effort to apply.

The MMS website has information on the application process and the webinars.

The state’s website has lots of good background information on the overall project.