PCMH Certification and Designing the Perfect Car

The Porsche Citroen 911Our clinic is now a Certified Patient-Centered Medical Home. The whole process leading up to this reminds me of one of my favorite subjects – buying cars. Specifically, buying cars based on technical specifications in color brochures. It takes real, on-the-road experience to know if a car is right for you.

When I moved to this country in 1981, I bought a 1980 Chevrolet Citation. Back in Sweden I had owned a Volvo wagon, but secretly admired the front-wheel-drive SAAB 900. Once in America, I figured I’d buy American. My wife’s relatives sent me car brochures to help me prepare for my choice of car.

The Citation sounded like America’s answer to the SAAB: a front-wheel-drive car with a powerful engine, quirky interior and a hatchback design. A car magazine at that time ran a comparison test between the Citation, the SAAB 900 and one of the German sports sedans, and the Citation almost won. I pretty much walked onto a used car lot and bought a silver Citation with red vinyl seats.

What does this have to do with PCMH certification?

Well, I bought a Citation based on a checklist of features that on paper made it look comparable to a SAAB. Once I owned it, I noticed the cracks between the door panels, the uneven paint and the awkward positioning of the controls, some of which felt like they could break if I wasn’t careful.

Not long afterward, I found myself hitting the front bumper on the pavement in sharp turns; I heard the rear shock absorbers snoring on dirt roads; I watched the dashboard dry out and crack in the temperate Maine summer weather, and I realized with the first frost that my car did’t have a rear defroster, and it never seemed to warm up in the winter.

For my thirtieth birthday, I traded the Citation for a second-hand SAAB 900. It fit me like a glove, and followed my every intention willingly and capably without body roll or tire squeal. I loved every minute of my commute – until the transmission locked up at 50 mph. It turned out that in order to get at the transmission, the whole engine needed to be dismounted. Three of those surgeries later, on a resident’s and, later, a new physician’s salary, the SAAB had to go.

PCMH Certification is a lot like reading car brochures: Front drive, check; horsepower, check; hatchback, check. But it doesn’t tell you about the quality, workmanship or usability of a product. It is only a qualifier for the race toward making the perfect car.

The Chevy looked like a modern car, but was more of a prototype for future front-drive American cars, and the SAAB was a niche car for enthusiasts who didn’t worry about the complexity and cost of repairs. Neither one was the answer in my quest for the perfect car.

I ended up with a German car, built by a company with deeper engineering know-how and bigger resources than SAAB. By today’s standard, my first Audi was only a little better than my beloved SAAB, but that brand continued to evolve, while SAAB went bankrupt and Chevy moved on, also through bankruptcy, to only decades later becoming a small contender in the global car market.

Audi/VW doesn’t have the panache of the quirky Swede, but it proved its staying power in a competitive market. Over the years I owned four Audis. Eventually, with my evolving gentleman farmer lifestyle, I moved on to a full-sized SUV.

PCMH Certification, like car prototypes, is only the beginning. If we all rested on our laurels now, we’d be driving home after work in our 1980 Chevy Citations.

Or, actually, you might say achieving PCMH certification is like earning your medical degree. It allows you to start learning from your own experience.

Hans Duvefelt, MD is a Swedish-born family physician in a small town in rural Maine.

5 replies »

  1. The PCMH is primarily concerned with: 1) data mining, 2) maximizing disease trolling, prescribing and referrals, 3) insulating large systems from real measures that truly reduce utilization/costs.
    The reimbursement has yet to materialize. That’s why it all runs on grant money right now. No surprise FQHC would do the same. It is a management fad designed to parasitize what remains of Primary Care.
    Commercial payers really want the data mining and are willing to throw Primary Care a pittance, after ignoring them for decades, to do this task for them. I think I can learn fine from my own experience without paying someone to watch me do it.

  2. The Joint Commision, one of the organizations that offer PCMH recognition, uses the word “certification”. No matter what you call it, Federally Qualified Health Center must achieve PCMH status or risk losing their grants, and many commercial payers will demand it, too.

  3. I understood that PCMH was offered as a “recognition program”, rather than a “certification program.” Has that changed?

  4. PCMH is a flawed concept that will do little to reduce costs or improve outcomes. It will serve as another gig or gimmick to maximally extract green backs from the United Staes.