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Doctors and Lawyers: The Patient Centered Medical Home as a Model for The Client Centered Legal Practice

Doctors and Lawyers: The Patient Centered Medical Home as a Model for The Client Centered Legal Practice

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Published by Ryan McClead
In the midst of the very same economic turmoil that set Law Firms spinning in 2007, a number of medical care professional organizations came together to craft the Patient Centered Medical Home, part manifesto, part best-practice guidelines, designed to put patients at the center of their own medical care. Law Firms should consider following their lead to establish guidelines for a Client Centered Legal Practice.
In the midst of the very same economic turmoil that set Law Firms spinning in 2007, a number of medical care professional organizations came together to craft the Patient Centered Medical Home, part manifesto, part best-practice guidelines, designed to put patients at the center of their own medical care. Law Firms should consider following their lead to establish guidelines for a Client Centered Legal Practice.

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Categories:Types, Business/Law
Published by: Ryan McClead on Jul 18, 2013
Copyright:Attribution Non-commercial

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03/31/2014

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DOCTORS AND LAWYERS
The Patient Centered Medical Home as a Model fora Client Centered Legal Practice
Part I: The Similarities 
Like all good children living far from where they grew up, I try to call myparents at least once a week. I usually discuss family matters with my mother for awhile, then she puts my father on and we talk shop. My father is the Medical Directorfor Quality Improvement Service at Nationwide Children's Hospital in Columbus, Ohio.To all appearances, he and I could not be in more different lines of work, and yet,over the last few years, we have noticed that our conversations about the legal andmedical businesses have overlapped a great deal.I often drone on and on about this correlation with my fellow 3 Geeks, and theygenerally nod politely, give each other a knowing sideways glance, and order anotherround of beers. Geek #1, Greg, recently tweaked my little pet topic by forwarding atweet from fellow blogger, and legal industry pundit, Jordan Furlong.As usual, I mostly agree with Jordan. However, I want to make a distinctionbetween the legal and healthcare systems and legal and healthcare businesses. Bothsystems are unquestionably flawed, difficult to navigate, and in desperate need of reform. But the systems are merely the environments in which the businessesoperate, not the businesses themselves. Law firms and hospitals are like exotic fish ina dirty aquarium. While many hospitals have begun to take a scientific approach tochanging the way they work in order to improve the functioning of their ecosystem,most law firms are comfortably swimming in their own filth and complaining aboutthe view.This is the point where many people pipe up and say, "Other than both beingprofessional service providers, doctors and lawyers have nothing in common." I willconcede that the law and medicine are very different practices, but I think it's a
 
 Doctors and Lawyers: The PCMH as a model for a CCLP 
by Ryan McClead- 2 -
mistake to conclude from that that the businesses of law and medicine are so wildlydifferent that one cannot learn anything from the other.First, doctors and lawyers aren't so different. They are both highly educatedprofessionals that use impenetrable language to practice their generally poorlyunderstood "dark arts", and are therefore simultaneously revered and despised by thegeneral public. A lot of physicians bristle at the idea of performing "cookbookmedicine", while most attorneys can't stand the thought of producing "commodity"legal work. Hospital medical staffs have historically been made up of solo and smallprivate practice physicians, while most BigLaw firms are partnerships in name onlyand are more closely akin to solo practitioners sharing support staff and office space.Physicians are extremely intelligent and trained to look for problems; since they canimagine all of the difficulties down the road, they will often reject potentiallyinnovative solutions out of hand. For many doctors, the patient relationship isproprietary, with some insisting that no one else should see or treat their patients,even at the expense of the patient's own health. Physicians often fall prey to thecircular logic that because they are successful, they must be doing things correctly,because they are successful, etc. (I stopped with the analogous attorney behavior,but drop me a line if you don't see the correlations.)In addition to the personal similarities between physicians and attorneys, thebusinesses of law and medicine are both currently undergoing extreme changescaused by forces largely outside of their control. Jordan Furlong, Bruce MacEwen,and our own Toby Brown, among many others, have written extensively about the outsideforces affecting firms - I won't reiterate their points here - but many similar forceshave been acting upon hospitals and doctors. As recently as ten years ago, even if they were affiliated with a hospital, most physicians were self-employed or in privatepractice. The rising cost of insurance, the needs to invest in technology (includingElectronic Medical Records and complex billing systems), and new requirements toaccount for performance quality, have led many solo and small practice doctors tojoin large conglomerate medical groups or become full-time hospital medical staff.Doctors are not "owners" of these companies in the same sense that law partners are"owners" of a firm, but the management of these newly affiliated, formerlyautonomous actors is remarkably similar to that of a law firm.While physicians and hospitals are fundamentally different entities thanattorneys and firms, I believe the modern relationships, interactions, and strugglesbetween Hospital, Doctor, and Patient are very analogous to those between Firm,Attorney, and Client. The medical profession is enduring its own New Normal and theyare dealing with it very differently than we are. It would be well within character,but we would be sorely remiss if we were to ignore their activity, and fail to learnfrom their experiences, simply because they are not attorneys.
Part II: The Patient Centered Medical Home 
In the midst of the very same economic turmoil that set Law Firms spinning in2007, a number of medical care professional organizations came together to craft thePatient Centered Medical Home (PCMH). The PCMH is part manifesto, part best-practice guidelines, designed to put patients at the center of their own medical care.
 
 Doctors and Lawyers: The PCMH as a model for a CCLP 
by Ryan McClead- 3 -
I believe the use of the word "home" in this case muddles the meaning, but it'sintended to be less off-putting and more inviting to patients than the words "MedicalPractice". The PCMH model, is an attempt to re-engineer the practice of medicinefrom the unholy mess that naturally evolved between the interactions of hospitals,doctors, government agencies, and insurance companies in the late 20th century, intoan efficient 21st century medical care machine, with patient well-being as its primaryfocus.There are four areas that the PCMH addresses:
Team-based Primary Care
is about doctors sharing the responsibility forpatient primary care with "nurses, care coordinators, patient educators, clinicalpharmacists, social workers, behavioral health specialists, and other team members."
i
 Historically, doctors have been very proprietary with patient access, refusing to allowother doctors, or especially non-doctors, to treat their patients. In a PCMH, data andrecords are openly shared (within appropriate regulatory guidelines) and primarypatient care is a group effort.
Active Patient Involvement
is making patients active participants in theirmedical care, rather than passive recipients of treatment. This requires the help of the larger team to educate and work with the patient to arrive at the best course of action.
Evidence-based Practice Improvement
means applying the scientific methodto common medical procedures, which sounds obvious, but has not always been thecase. Doctors, often believe that the way they have always done it is the best way todo something. Practice improvement challenges the status-quo by testing andconfirming best practices with actual data rather than anecdotal evidence.And finally,
Payment Reform
is restructuring the way that doctors andinsurance companies are paid to align the financial incentives in the medical industrywith the needs of the patient, instead of the needs of the medical practitioners orinsurance companies.This sounds great, but the value is not in defining the areas that need reform,but in actually creating a clear path to get there. There is a regulatory component tothe PCMH that is administered by a non-profit organization called theNationalCommittee for Quality Assurance (NCQA).NCQA has established clear guidelines for any medical practice to qualify as aPCMH. They've broken the guidelines down into 6 distinct Standards which eachinclude between 2 and 7 individually scored elements and a single Must-Pass Element.The Must-Pass Elements are: 1) Access During Office Hours; 2) Use Data for PopulationManagement; 3) Care Management; 4) Support Self-Care Process; 5) Referral Trackingand Follow-Up; and 6) Implement Continuous Quality Improvement. These 6 Must-Pass Elements are things that any competent medical practice should already bedoing.

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