Election Wrap-Up, Patient-Centered Medical Home Practices [Pennsylvania Newsmakers]

I welcome to Pennsylvania newsmakers and as always thanks for watching well we had a rather docile should i say off-year election and then we’re going to get a little legislative preview with a couple of the state’s leading journalists and what about patient-centered medical home boy this is a fascinating new approach you’re going to hear about it on the show right now this is Pennsylvania newsmakers a fast-paced unrehearsed weekly discussion with and about the leaders who shake your world and now here’s your host Terry Madonna I welcome back to the program well we’ve got John my succeeding across from me and Tony Romeo John is with the Allentown morning call Tony Romeo KYW KDKA radio frequent the guests on the program alright guys look dasol may be an overstatement for this election John low turnout a couple of big primaries what what’s your takeaway there was an election because what is like my gosh what lower than maybe twenty percent if you’re super lucky it was pouring out on Tuesday to which kind of discourages people from coming out on the polls it’s one of these years where it off your elections is hard to draw up interest but this year in particular there was no I mean it was super local there are no marquee races and we’re getting obsessed now about maybe a Commonwealth Court recount between two Democratic candidates I mean that ought to tell you something about about the level of glamour in this contest but before I go to Tony about the Philadelphia mayor’s race in a minute but before I do that it looked like for the most part that even though we’ve got this Commonwealth Court you know like everybody out there knows and names I don’t even know their names John’s gonna have to tell me party ruled I mean it as I looked around the state not everywhere but the party indoors candidates seem to do pretty well in both parties right yeah I mean that was the case we had rich Fitzgerald in allegheny county the county the party endorsed candidate there won handily winning winning handily Mayor Mike Nutter in Philadelphia is going to mention a moment won the Democratic nomination in Philly you know in races like this party rules because regular voters now it was so it was Milton Milton Street spent a little time in what a courtesy of the federal government where you what you can say federal prison right still owes what a million bucks or something in back taxes or whatever that is he thirty percent what go ahead that’s interesting I it doesn’t seem to have any implications for the fall elections it’s hard to imagine a Republican really making a challenge to a democratic candidate in Philadelphia given the structure and the calculus there in that city was seen being so heavily dominated but nonetheless it is interesting to me that a candidate with is as much baggage as Milton Street had could could carve out that much of them well his younger brother John Street changed his party registration to become an independent so maybe the mayor nutter and Phil have to run it is a source of a lot of psychotic another Street maybe if we’re saying maybe right maybe who knows and then the other thing just in Harrisburg where this show is taped the Mayor of the City of Harrisburg has her hands full now that it looks like the it doesn’t look like three Democrats elected to City Council two incumbents and the third would a new one are not in her camp so so it looks like the mayor the mayor is Linda Thompson is in for a rough couple of years that does all right all right let’s turn now our attention to the legislature returns with a full agenda as I think both you guys been a good bit of your time culling Harrisburg Tony let’s start with you the budget House passed the budget 27.3 a billion fooled around a bit with education reduced some of the cuts let me start with this question Republicans own Harrisburg do they get it done by june 30 we’re pushing pretty quickly well massage a little bit i don’t believe the house has actually passed the budget yet the Republicans have proposed it oh they didn’t ask it came out of appropriate okay madam appropriate for all intents and purposes it will pass pass it’s expected to pass the Republican that’s why have you guys are great but but the reality is is that in spite of the fact that Republicans control all the levers of power in Harrisburg there are some interesting disagreements right now on how the budget is yeah the Republicans are restoring in the house or restoring some money to education in higher education restoring some of the steep cuts that the governor proposed by budgeting for savings in the welfare department that they believe will be found through real immitating errors and fraud savings that Governor Corbett does not think should be budgeted for he thinks that they’re there but he doesn’t think you can balance you’ll even get them get them out by the next year and then on the other side and the Senate there is this surplus in the current budget it sounds funny to say there’s a surplus but in the current budget we’re five hundred million dollars in counting above

projections for this fiscal year that could be put toward what’s expected to be a massive deficit in the next budget and the Republicans in the Senate say we should spend that Governor Corbett doesn’t want to so I’ve got these big differences at the moment but John you’ve been through this both of you guys have been through this before the party you got you know one party in power they hold if they hold ranks firm they can do pretty much what they want yes no yes let go ahead I mean everyone so there’s this assumption that when the Republicans cleaned up last year that with big majorities in the House and Senate everything was going to be fine with Governor Corbett didn’t in the in the governor’s office just a reminder that all families squabble I mean ultimately there’s going to be there’s going to be a budget at the end of this thing it’s probably gonna look more or less like what the governor governor said it was going to look like in with the house but the money put back in for higher end and that kind of thing where this could also get kind of hinky is in all ways with these so-called side car issues these these bills that pop up that in there and verily get tied into the budget negotiations for instance the the Marcellus Shale impact fee and school choice I want to talk about those in a minute so I mean that’s another place where there could be sort of side stage drama all right we run into a break Marcellus Shale school choice big big issues there governor part of it governor doesn’t want Marcellus Shale we won school choice will we get them our experts will tell us when we return this broadcast of Pennsylvania newsmakers is presented by the Pennsylvania chamber of business and industry the statewide voice of business and by the Pennsylvania cyber charter school bringing educational innovation and freedom to the children of Pennsylvania this broadcast of Pennsylvania newsmakers is presented by reconnect PA org supporting a comprehensive transportation funding solution and by the Pennsylvania Manufacturers Association business in Pennsylvania is our business I welcome back with John my sick and Tony Romeo both the reporters longtime observers and chroniclers of of all things Harrisburg and state politics a guy got that out didn’t I all right we got two big things going on we got Marcellus Shale the governor says no no no no way impact fee Tony Romeo we have the the the big guy in the Senate the president pro tem pat feed bill i want to pass it but what’s the situation with that well just before the break you made a very you know important observation that is most of the budget impasses we’ve had during the Rendell years over the last previous eight years had to do with what the sidecar issues being covered on the budget is John put it this year i think that the major sidecar issue will be the impact fee i don’t think that school choice is going to happen before the recess and the Senate Republican leader has a basic go what’s the issue ok so he good governor says no to an impact fees no yes now he wants to wait until his commission reports and then that’ll be the out ryan course they’ll probably he doesn’t want senator Scarnati to push that bill right also you know there’s also this issue of no fee vs attacks the governor made in no tax fee and i think you have the Senate President Pro Tem here walking a fine line trying to paint this as a fee and not a tax but you know it’s the old story of if it quacks like a tax and walks like he’s going to have to John my sick he’s going out to you know the President Pro Tem of the Senate is not exactly an unbiased powerful if that’s a word leader right i mean if he wants to but he wants to press this issue he can certainly press this issue i mean the more you get into it is the governor said he’s willing to examine he wants to talk about the impacts of but you know i was willing to consider all that but he wants to make sure that no money comes back to her general fine senators Carnegie’s bill has a provision in it where some of this money would be redistributed for highway and bridge projects and conservation projects statewide they got Iron Man environmental and the governor is not the governor’s not into that so that’s another another wrinkle there the house is kind of lukewarm on it as well they’re saying they don’t want to do any sort of text and/or fee increase you could see some severe horse trading going over there but the one thing that I’ve noticed just in following the news paper covered TV and radio coverage of this this is energized a lot of people not just in the environmental community I think there’s deep every day we hear about well there’s this problem with a well that’s leached out you know their water concerns Tony Tony how big a deal does this become I mean it seems to me it’s growing by leaps and bounds am I right or wrong about already a big deal and quite frankly as we were chatting during the break you know as soon as I heard about this Marcellus gas shale formation years ago and what had to be done to fracture the rock deep in the ground to get the gas out i thought oh this is going to be something we’re going to be talking about for for Declan

I mean this just isn’t something that’s sort of a policy conversation either and if you talk to people who are sort of outside the very narrow orbit that we all operate in a pub there’s out there in the wider world within the public there is no short it’s a new shortage of opinion on this and there’s just mass confusion as to why there’s not a severance tax being imposed on these drillers and this is one of the great a one of the great policy challenges of the next ten years but also it’s going to be this great public conversation of the next 10 or 15 years I mean people in a way that they don’t get engaged and say talks over property taxes or over school choice in the wider world are engaged in us as she disposed of the environment so do you think it’s big now and it’s going to continue to grow rice yes all right I want it before you get out of here I want to ask you about school choice it’s become you know but voters aren’t in favor about all the posts polls show that Governor Corbett is committed to you know taking a piece of state funds allowing students in poor districts this is a big deal in the in the state Senate where we’ve got a Democratic senator and a Republican senator of Philadelphia guy Tony I know that you covered Tony Williams and Senator piccola they’re pushing this very hard school choice if it doesn’t get done now Tony Romeo doesn’t get done at all well the I think it may compare the small fair chance in the fall you know but it is interesting the the week before this show week before last that the House passed a bill that would expand a tax credit for businesses that donate to scholarships for school children that was seen by many as even though the Senate bill voucher bill hasn’t that that same component to expand that tax credit the house action was seen as house being hearing a finger in the eye to school valve or or at least that they’re hinky about it and this is an alternate event yeah and there are a lot of we’ve talked about this there are a lot of Republicans in the House we’re still skeptical of the vouchers program for a number for a number of reasons it with this eitc voters it’s known as was seen a sort of a more politically palatable alternative got over to the Senate and landed with a thud with Jeff micole the Education Committee Chairman the father of vouchers GOP father about use declaring a dead on arrival all right but the final word here is that this isn’t going to hold up the budget now you think they’re going to do the budget and if they have to jettison school choice until the fall by the senate majority leader has already said he thinks because of the house action that does it be put off now just me but all right great great great up the shale impact fees i think are going to be are going to be okay good update patient-centered medical homes we’re going to find out about that boy this is a new concept you don’t want to miss see you around the corner this broadcast of pennsylvania newsmakers is brought to you by Pennsylvania credit union Association Pennsylvania credit unions where people are worth more than money to find a credit union that is right for you check out I villano RG and by the Energy Association of Pennsylvania Pennsylvania’s energy information source this broadcast of Pennsylvania newsmakers is presented by the state system of higher education 14 state-owned universities the state system is the largest provider of higher education in Pennsylvania and by the hospital and health system Association of Pennsylvania working towards a healthy pennsylvania patient-centered medical homes i introduced this as a new concept I’m hearing from our medical experts well a few little adaptions right you’re going to tell me about that joining me is dr. robert nielsen he’s with the anvil family practice you’ve been on the program before and the senior medical director with high mark dr. Andrew blast you check did I get that right see I’m getting better I know I you know Madonna it’s not quite to say all right dr. look what what’s this concept and why should people care about it well it’s um as we were saying earlier it’s not completely a new concept the concept of a medical home or components of it had been around for gosh probably 40 years but over the last couple years it’s really build up some steam with endorsements by a family practice academy pediatric Academy with with literature that’s been written about the successes but but essentially it’s uh from my standpoint it’s a transformation in in primary care in in office practice it includes the physician really leading a team in the in the office but also it includes a lot of the IT a lot of the electronic health record and use of the data on patients to manage those patients with a focus on quality access to care and and also a very important part is is a change in the reimbursement for patient care to all right you’re are you you’re in the process of doing this now right grip walk through it start out I mean a

patient comes in and you’re looking at the patient and what would you say about what that means to the patient let me to the patient is that we’re going to try to focus on a group of people being involved in their care so then I don’t you know in a typical 15 or 20-minute office visit there are so many items to bring on the agenda patient has an agenda there have their diabetes that have their high blood pressure we’re trying to get their preventive healthcare done they come in with a cold their family member has a question about how to get mom or dad to the to the next level of service a lot to accomplish in a short period of time so every so so they in addition to seeing you for you they would have three or four other people that would interact with them that would perform certain functions and that’s not so unusual but is it the coordination of this that makes it unique equation cohesion in communications yes go ahead yeah we have a we’ve enhanced the roles that nurses are playing in the office we have diabetic educators who are working specifically on that we’re taking a look at the demographics of our practice we’re thinking more about population health as well as the individual the flock of people who call your practice home how do they get their care how well are the diabetes being taken care of what are the outcome measures what’s their access to your office how often can they get in can they get in the evening to see I don’t want to interrupt you but these are all it sounds to me very significant in terms of how patients react to the care they get I mean is that is that right I agree my green although you know when I when I first heard of the concept medical home a couple years ago was actually through the Pennsylvania Kadri family physicians and some educational programs and when they talked about we need to coordinate care better and such my first thoughts were isn’t this what we do anyway but but as you look into the details and and really the the heart of it is in the details that that that communication part between dr. Nielsen’s practice and a hospital of the patients in there and in reducing emergency room visits or hospital readmissions what has it what you’re saying is it has ramifications just sort of well beyond a patient walking into an office to see one of you guys right absolutely good point how we communicate with one another how we how we prevent duplication of services how do i how do we get the labs that were done at the cardiologists into our office chart so we don’t order them again you know there’s there’s there’s waste in the system and it’s a cop I mean you know you know I’ve obviously been seeing a doctor my whole life I remember when I would go and go into the office the doctor would meet me spend we’d have this conversation he’d do a test or two now this is a hugely complicated world I mean with a battery of tests coming in a battery of things things that need to be done I mean it’s hard with all the patients that you’ve got to keep this all straight so this is there a coordinator of all this we do in our in our office so we have ten physician providers and a couple of mid levels each one of our teams where three of them will evolve to having a nurse care manager who will be involved in helping us look at some of the informatics some of the output from the computer esterday to try to designate who’s at high risk who needs more services to do callbacks to make sure that you know I marry got the medications coordinated did medication reconciliation so many hospitals just not we’re going to run to a break some other things I want to ask you so it’s just not walking in the office and having one of you guys see a patient and give a prescription and then you’re out the door right it’s those days anymore those days are long gone all right this is a not a new concept but an important concept that the folks at highmark are working on we’ll continue this discussion after we absolutely pay some bills this broadcast of Pennsylvania newsmakers is presented by Highmark Blue Shield changing the way health plans work for business with a variety of plan options for employers and more choices for employees information is available at high Mach com have a greater hand in your company south and by the Pennsylvania health care association the future of long-term care welcome back to the program we’re talking about a medical home now medical home is not like a home where you live it’s a home where you go and get like a complete set of services do I have that right correct I want to make sure I got that now this care coordination is really central to this and someone go ahead you know where I’m heading I agree that the care coordination piece is central as is the electronic health record and the use of the electronic health record registries but there’s a lot of work being done before you as a patient even comes into the office dr Nelson’s office his staff is care coordinator care manager will be looking over the the data on diabetic patients looking to see what their sugar control

has been if the patient needs a one service versus another and arranging for those services now this electronic before I want to pickle you know electronic record-keeping you know I was we’re doing shows on this when it came about him I know how i right you can’t read it and hybrids and I know how you doctors right i mean you know you wrote it just really made some difference as it it it’s a huge difference not not only in recording data but how you can get at data how you can review data and more importantly how you can put the decision support system so that when you walk into the office and we’re trying to figure out what preventive services you might need based upon your gender your age or your medical conditions we’re able to get to that very quickly as opposed to trying to thumb through a chart we can also then expand that to a population base we take a regular look at our patients in our practice we have 1200 diabetics five years ago I couldn’t have told you that we can take a look at those diabetics who are under good control those who aren’t under good control we can call them up and say look let’s get you in and see our diabetic educator focus on that so we can take care of the flock a little bit better what about reducing medical costs here well that’s one thing or pilots going to look at as well as the quality metrics that are attained in the medical home there are studies that were reported of reductions in emergency room use because of the access reductions in in hospital admissions and readmissions so there has been some studies written we feel that that will probably see the same the governor’s initiative has in keeping people out of emergency rooms I mean we all know that that’s fairly expensive not blaming the hospital for this but it is for and people going there for things that they should be going to see am i right about you usually you’re on the front end of this absolutely all right we got about a minute left what’s the most change has been the most radical or extreme whatever word you want to use number one the use of electronic record and beginning develops the technology and having patients interact with most multiple care providers and getting them to understand that that’s an okay thing that we do communicate that we do work together as a team and that will enhance their care yeah look I want to thank both of you hope you when this gets going maybe you’ll come back in a year or so and talk to us some more about this and we’ll see if this is a trend across I’ll see what like all changes and we’ll see where it goes all right as always thanks for watching this edition of Pennsylvania newsmakers and stay well