Fred N. Pelzman, MD

Articles, page 5

September 12, 2014Sep 12, 20144

The state stopped by to see us the other day. Wow, that sounds ominous. No, really, I mean it felt like the entire Empire State: multiple people from multiple offices of New York state government, department of health, office of…

The state stopped by to see us the other day.

Wow, that sounds ominous.

No, really, I mean it felt like the entire Empire State: multiple people from multiple offices of New York state government, department of health, office of compliance this, oversight that, all with a vested interest in how things have been going (i.e., how we have been spending their money) in our patient-centered medical home resident pilot program.

A few …

Physician voices

Actionable items: Reduce the work for physicians

Fred N. Pelzman, MD

September 7, 2014Sep 7, 201415

Actionable items. Today I decided to take a look at one of the dashboards that the information technology (IT) department built for our electronic health record, to help us a look at our patients enrolled in the multiple registries of…

Actionable items.

Today I decided to take a look at one of the dashboards that the information technology (IT) department built for our electronic health record, to help us a look at our patients enrolled in the multiple registries of diseases and conditions we are following for the patient-centered medical home.

I booted up the program, and with just a couple of clicks of the mouse the program began running, checking with …

Physician voices

What being overwhelmed by rules and regulations looks like

Fred N. Pelzman, MD

August 31, 2014Aug 31, 201426

My morning practice session started out with a few patients arriving early, so I was able to get a jump on the day, and it looked like I was going to actually be running on time. As I was walking…

My morning practice session started out with a few patients arriving early, so I was able to get a jump on the day, and it looked like I was going to actually be running on time.

As I was walking from one exam room to the other, my administrator came down the hallway, grabbed my arm and said, “Can I have you for a minute?”

It seems that a group of systems …

Physician voices

Incorporating urgent care into the medical home

Fred N. Pelzman, MD

August 16, 2014Aug 16, 2014

During her annual physical exam, one of my patients recently asked me, "Are urgent care centers any good, Dr. P?" She recounted an incident a few months earlier where she awoke with an acute illness and was sick enough that…

During her annual physical exam, one of my patients recently asked me, “Are urgent care centers any good, Dr. P?”

She recounted an incident a few months earlier where she awoke with an acute illness and was sick enough that she felt she needed to receive care — at least some medical attention — more imminently than she could get from waiting to speak to my office in the morning. She …

Health policy

Blank pages are emblematic of health care waste

Fred N. Pelzman, MD

July 2, 2014Jul 2, 2014

Opening my mail today, there are multiple letters from multiple insurance companies, reportedly communicating valuable information to me about my panel of patients that they cover. One of the envelopes holds two single sheets of paper, one of which contains…

Opening my mail today, there are multiple letters from multiple insurance companies, reportedly communicating valuable information to me about my panel of patients that they cover.

One of the envelopes holds two single sheets of paper, one of which contains a listing of my panel of patients and the providers they have been referred to over the past quarter.

The second sheet, mysteriously, contains only a single line: This page intentionally left …

Physician voices

The patient-centered medical home isn’t ready-made

Fred N. Pelzman, MD

June 29, 2014Jun 29, 2014

It's a cold and rainy morning, and we've traveled to the middle of Central Pennsylvania to see a presentation at a conference about a patient-centered medical home product produced by one of the largest health care systems and insurers of…

It’s a cold and rainy morning, and we’ve traveled to the middle of Central Pennsylvania to see a presentation at a conference about a patient-centered medical home product produced by one of the largest health care systems and insurers of the region.

There are clinicians and administrators from all over the eastern half of the U.S. (plus one from California), and also a large contingent visiting from the U.K., on a …

Health technology

The EHR should work for us, not us for it

Fred N. Pelzman, MD

June 14, 2014Jun 14, 201413

I'm feeling meaningfully used today. Once again, we are faced with another set of administrative hurdles, boxes that need to be clicked, tasks that need to be completed, all in the name of demonstrating that we are meaningfully using the…

I’m feeling meaningfully used today.

Once again, we are faced with another set of administrative hurdles, boxes that need to be clicked, tasks that need to be completed, all in the name of demonstrating that we are meaningfully using the electronic health record in which our practice and the federal government have so heavily invested.

An “eligible professional summary” arrives in my email, with lots of bars with lines, and green checks …

Physician voices

When is too much data a bad thing?

Fred N. Pelzman, MD

June 7, 2014Jun 7, 20147

"Here you go, doctor." My patient with incredibly well-controlled type 2 diabetes hands me his fingerstick log at his regularly scheduled office visit. Despite his multiple medical problems (congestive heart failure, coronary artery disease, chronic renal insufficiency, and gout, among…

“Here you go, doctor.”

My patient with incredibly well-controlled type 2 diabetes hands me his fingerstick log at his regularly scheduled office visit. Despite his multiple medical problems (congestive heart failure, coronary artery disease, chronic renal insufficiency, and gout, among others) his sugars have been incredibly well-controlled over the past several years.

Page after page of scrawled numbers, tiny smears of his blood on the pages, his fingersticks range from 90 to …

Read more…

When is too much data a bad thing?

Physician voices

Continuity of care increases patient satisfaction

Fred N. Pelzman, MD

May 18, 2014May 18, 20143

Greater discontinuity equals greater dissatisfaction. On Wednesday afternoon, one of the residents stopped in my office to talk about a patient he had just gotten off the phone with. It was a patient of his who had asthma and a…

Greater discontinuity equals greater dissatisfaction.

On Wednesday afternoon, one of the residents stopped in my office to talk about a patient he had just gotten off the phone with. It was a patient of his who had asthma and a recent upper respiratory tract infection for which she had received treatment at an urgent care center with an oral antibiotic and a course of steroids.

She told him that she was still …

Physician voices

Improving patient access to primary care

Fred N. Pelzman, MD

May 10, 2014May 10, 201414

At a recent faculty meeting, the attendings in our practice were asked about their availability for new patient appointments. The vast majority reported that due to time constraints and patient volume, they had closed their panels to new patients. For…

For those of my partners with open schedules, the wait for new patients to be seen was averaging 2 to 3 months, a few up to 6 months. The time to the …

Physician voices

Is it any wonder why young doctors shun primary care?

Fred N. Pelzman, MD

March 23, 2014Mar 23, 201414

With the announcement out of Washington about the 2015 budget, much has been made about the apparent presence of significant support for the development of more primary care practitioners in the years ahead. This support includes programs aimed to encourage…

This support includes programs aimed to encourage medical students and residents to choose primary care as a profession, including loan forgiveness packages.

Response in the press has already raised issues with this, suggesting that this move would do little …

Physician voices

Give the medical home more time before declaring it a failure

Fred N. Pelzman, MD

March 1, 2014Mar 1, 201423

During an afternoon seminar on a new paradigm for lung cancer screening in primary care, my phone chirped announcing the latest MedPage Today bit of breaking news: "Medical Homes May Not Be the Answer." A study in JAMA reported that…

During an afternoon seminar on a new paradigm for lung cancer screening in primary care, my phone chirped announcing the latest MedPage Today bit of breaking news: “Medical Homes May Not Be the Answer.”

A study in JAMA reported that cost per month per patient had actually increased, and only one marker of improved care was found to have improved after thousands of patients were followed in a large group of patient-centered medical …

Physician voices

Huddling in the medical home: Sounds good on paper

Fred N. Pelzman, MD

February 23, 2014Feb 23, 201448

"Just start work half an hour earlier." This is what the head of the care coordination committee for our patient-centered medical home executive committee work group recommended when we talked about our struggle getting the team together for early-morning pre-clinic…

“Just start work half an hour earlier.”

This is what the head of the care coordination committee for our patient-centered medical home executive committee work group recommended when we talked about our struggle getting the team together for early-morning pre-clinic huddles.

She suggested that if we started our usual practice morning at 8 o’clock we should just have everybody come in at 7:30 to load the dashboards for the morning session …

Physician voices

What is a high risk patient?

Fred N. Pelzman, MD

February 2, 2014Feb 2, 20142

"What's a high-risk patient?" asked our newly hired care coordinator. Interesting question, and, as you would expect, one without an easy answer. One of our patient-centered medical home certifying agencies was performing an audit for recertification, and requested information on…

“What’s a high-risk patient?” asked our newly hired care coordinator.

Interesting question, and, as you would expect, one without an easy answer.

One of our patient-centered medical home certifying agencies was performing an audit for recertification, and requested information on our high-risk patient registry, including how patients were identified and assigned to the registry.

When you ask doctors or any other providers, we all know one when we see …

Read more…

What is a high risk patient?

Physician voices

For the medical home to be successful, listen to the patients

Fred N. Pelzman, MD

January 12, 2014Jan 12, 201420

Standing in the middle of a massive hotel convention center hallway with thousands of people wearing name tags. Not where I usually spend my days. I have been asked to join senior management at a national client conference for the…

Standing in the middle of a massive hotel convention center hallway with thousands of people wearing name tags.

Not where I usually spend my days.

I have been asked to join senior management at a national client conference for the company that is providing patient survey data to our institution, those surveys patients get in the mail asking about their “experience” during their visit to our practice.

Everybody here wants the same thing, …

Physician voices

Building the medical home requires incremental steps

Fred N. Pelzman, MD

December 22, 2013Dec 22, 20135

Recently a colleague from IT who is working with us on our patient-centered medical home asked me, "when is the rollout date for your patient-centered medical home?" As we have gone through this process for the past six months, I…

Recently a colleague from IT who is working with us on our patient-centered medical home asked me, “when is the rollout date for your patient-centered medical home?”

As we have gone through this process for the past six months, I can definitely answer that there is no one day when this is going to happen. We are not going to close the door one night, turn out the lights, shut down …

Physician voices

How the medical home can spur academic research

Fred N. Pelzman, MD

December 15, 2013Dec 15, 2013

As we've gone through the process of building our patient-centered medical home, we have brought along a little bit of the scientific method. As part of the medical home rollout, we developed an expanded quality improvement curriculum for our internal…

As we’ve gone through the process of building our patient-centered medical home, we have brought along a little bit of the scientific method.

As part of the medical home rollout, we developed an expanded quality improvement curriculum for our internal medicine residents. A series of talks on key topics of the patient-centered medical home has been developed, and several faculty experts have been delivering these to the residents. As a part …

Physician voices

Patients must be given the results of their tests

Fred N. Pelzman, MD

November 28, 2013Nov 28, 201320

Just the other day one of the medicine residents presented a case to me, and mentioned that in looking through the patient's chart he noticed that the patient had undergone a prostate biopsy 1 month prior to this visit, with…

Just the other day one of the medicine residents presented a case to me, and mentioned that in looking through the patient’s chart he noticed that the patient had undergone a prostate biopsy 1 month prior to this visit, with a follow-up appointment in urology scheduled next month. The result of the biopsy was positive for cancer, but that had not been communicated to the patient. His first instinct, he …

Physician voices

Knowing who your PCP is in the medical home

Fred N. Pelzman, MD

November 3, 2013Nov 3, 201330

Integral to the very concept of the patient-centered medical home is the need for a very real, very concrete, one-on-one relationship between the patient and his or her primary care provider. No matter who this is, the patient needs to…

Integral to the very concept of the patient-centered medical home is the need for a very real, very concrete, one-on-one relationship between the patient and his or her primary care provider.

No matter who this is, the patient needs to know who their internist, or gynecologist, or pediatrician, or nurse practitioner, or other primary care provider is. Nothing can replace this, and everything else about the patient-centered medical home is designed …

Physician voices

When patients move beyond the medical home

Fred N. Pelzman, MD

October 13, 2013Oct 13, 2013

Even in its purest form, in the most perfect patient-centered medical home we can create, patients will sometimes need to move beyond the confines of primary care. Each of us in primary care has a point that we choose not…

Even in its purest form, in the most perfect patient-centered medical home we can create, patients will sometimes need to move beyond the confines of primary care.

Each of us in primary care has a point that we choose not to venture beyond, into the realm of subspecialty medicine where we lack the experience and tools and support to fully implement complete care for patients with these particular problems.

It may be …