Patients advise doctors on ways to reform medical practice

The patients have spoken, and they want better and easier communication with their doctors. At CapitalCare Medical Group, patients have told managers they want to talk to a person, not navigate a machine's menu, when they call the office. But they also want to leave a detailed message about symptoms or request a prescription refill at odd times of night. And they could use a brochure with a list of services, as well as the direct phone numbers of the people who can answer questions.

So CapitalCare changed employees' schedules to make sure a person was always available by phone, even during lunch, and added a Web portal for patients to leave emails and check personal information. Managers produced that brochure, which has become a marketing tool for new patients, said nurse practitioner Carol Braungart. All at the suggestion of their new Patient Advisory Councils, established last year to meet the requirements of a federal experiment in improving three aspects of health care: costs, outcomes and patient experience.

CapitalCare offices and 65 others in the Capital Region and Hudson Valley are participating in the federal Comprehensive Primary Care Initiative. The upstate New York region was one of seven nationwide, representing almost 500 practices, selected by the federal Centers for Medicare & Medicaid Services to participate. The goals include bolstering primary care and rewarding providers who keep their patients healthier and avoid costly services like hospital visits.

Participating medical practices are paid a set fee per patient per month rather than the traditional way — each time they perform a service. This payment model in theory promotes early medical interventions, when services are less expensive, rather than rewarding doctors for costly care that comes late. The per-patient monthly fee averages $20, and will be reduced to about $15 after the first two years, according to CMS. Participating practices will also share in savings the program provides to the federal government.