More Connecticut doctors are adopting electronic medical records, but they are behind in implementing many of the key components of the medical home concept, a key aspect of health care reform that aims to change the way physicians' coordinate patients care, according to a recent industry study.
About 39 percent of the 498 primary-care physicians surveyed by the Connecticut State Medical Society said they use electronic medical records, up from 25.8 percent in 2008.
That's a good sign, industry officials say, as electronic medical records are seen as a key component in helping to drive down health care costs by creating more efficient and coordinated care environments.
But the study also found that many of the core components of the medical home concept — like hiring a care manager or adopting primary care teams — are not yet widely implemented in Connecticut.
And the biggest factor preventing its expanded use is cost, especially for the smaller practitioners who still dominate the market place in Connecticut.
"The findings related to medical home adoption are not too surprising in the context of how medical care is delivered in Connecticut," said David S. Katz, president of the medical society. "The majority of physicians in our state are in small or solo practices, and the kind of coordinated care that is the hallmark of the medical home approach can require more administrative support than these practices can provide."
The idea behind medical homes is to use primary care physicians as central figures in coordinating patient's care among specialists, hospitals and other health care providers.
That reduces costs over the long term, the thinking goes, by eliminating duplicative care and encouraging preventative services that help to root out serious diseases or health problems before they develop.
How does it all work? Under the model, a diabetic patient, for example, might have a chronic care manager that makes sure the patient has filled their prescription and taken their medications. The patient might also participate in group meetings with other diabetic patients to find better ways to treat their condition.
By monitoring the patient and providing coordinated care, there will be less chance the patient gets really sick and is forced to go to the emergency room, where costs go up tremendously, Katz said.
But, while it all sounds great, it's also an expensive proposition, Katz said. Implementing electronic medical records, which is a key component of the medical home concept, can cost $15,000 to $20,000 per physician.
At the same time, more than half of Connecticut physician practices have fewer than five doctors, which mean the practices have limited access to capital and are often financially unable to support team-based care, like hiring a case manager.
According to the medical society study, only 20 percent of the family practices, internists and pediatricians surveyed have or plan to hire a nurse care manager, and only 25 percent have or plan to establish primary care teams.
And many of the medical home aspects like additional staff work and care coordination aren't reimbursed by commercial or government payers.
"It's a daunting task for many physicians," Katz said.
Among the positive findings in the survey is the increased adoption of electronic health records among physicians.
Nearly 40 percent of doctors now use the technology and Katz said physicians in larger practices are leading the charge because they have financial wherewithal to do it.
That has led to some speculation among industry experts that there will be increased consolidation among smaller physician practices in the coming months and years, as pressure mounts under federal and state reform efforts to adopt new technology.
Many independent Connecticut doctors may need to affiliate with — or join — a larger physician group or hospital system to make ends meet, some industry observers say.
Another medical home aspect that is on the rise is the use of advanced or open access scheduling, which is the practice of reserving regular appointment times in a physician's daily schedule to accommodate patients with acute needs.
About 64 percent of physicians surveyed said they use the scheduling technique, which has reduced wait times for patients by 35 percent.
That translates to average wait times of 9.9 days rather than 15.3 days for patients in need of medical care.