IdealMicroPractices IdealMedicalPractices

1. IdealMicroPracticesIdealMedicalPractices Jean Antonucci MD

2. Micropractice An Emerging model of Care

4. Institute of Medicine, National Academy of Science • Committee on Health Care in America • 1998 formation of committee Charge: Develop a strategy that will result in a substantial improvement in the quality of health care in America over the next 10 years • 2001 Publication of Crossing the Quality Chasm

5. TOOLS Crossing the Quality Chasm Radical redesign of the system needed 6 aims • Safety • Timeliness • Efficiency • Effective • Equitable • Patient centered collaborative care • Low overhead • Access • EMR • Continuity • Small functional units • Measuring stick (HYH)

6. Picker Institute definition: • Respect for patients values • Preferences and expressed needs • Information and education • Access to care • emotional support • Involvement of family and friends • Continuity of care • Physical comfort • Coordination of care

7. “In its current forms, habits and environments, the American health care system is incapable of providing the public with the quality health care it expects and deserves.”

8. “It is not that providers lack dedication or compassion…” “The system is perfectly designed to give the results it does.”

9. What Is An IMP? • IMP is a way of practicing • IMP is an innovative program designed to engage physicans at a low threshold through a virtual community and asynchronous learning, to pursue quality patient centered care

10. Impcenter.org

11. The mechanisms of IMP • low overhead and the smallest functional unit for delivering care leverages technology to maximize efficiency, continuity, collaborative care and access • must give patient centered measures and feedback to all • Need not be solo • not concierge usually • may not work in dead zones

12. IMP is • A way of practicing • providing the patient a superb experience of care • In a vital and sustainable environment for the doc

13. Began as an experiment using technology to leverage overhead to provide more breathing room • Progressed to a National Collaborative project that began in 2006 funded by the Physician’s Foundation for Health Excellence and the Commonwealth Fund

15. Redesign a practice to incorporate principles of microsystem work- • to be patient centered • to have superb flow of processes • To revitalize practice

16. “It is not that providers lack dedication or compassion…” “The system is perfectly designed to give the results it does.”

20. What is needed to do the work: access to information - information on guidelines - the patients information Efficient office design Open access scheduling Reliable tickler system Medical knowledge +care giving skills + these tools = Quality System.

21. PATIENT-PHYSICIAN IDEALIZED MICROPRACTICE WORKFLOW Pre-visit: appointment through web based scheduler Completes labs IMH and HYH BEFORE visit Visit: On-time start All data at hand during visit Review EB condition-specific best practices on web Patient receives post visit summary Between visits: Easy access 24/7 email and voicemail Results, minor issues, questions addressed via email/phone

22. Resources • http://www.impcenter.org • IMP Listserv: http://health.groups.yahoo.com/ • group/Practice improvement1/ • Green Book on the Dartmouth Clinical Microsystems www.clinicalmicrosystems.org • Family Practice Management Articles: http://www.aafp.org/online/en/home/publications/journals/fpm.html Authors Moore, Ho, Eads, Guinn

23. WHY PHYSICIANS CHOOSE MICROPRACTICE --Physician satisfaction • Absolute autonomy • Zero practice inertia • No practice administrators • SATISFACTION WITH QUALITY OF PATIENT-PHYSICIAN INTERACTION

24. WHY PATIENTS CHOOSE MICROPRACTICES -Patient satisfaction -Patients have time to tell their stories -Smaller panels, Patients feel they are not just a number -Patients and physicians have time for collaborative decision making -Patients enjoy highly efficient office design

25. Micropractices value lie in addressing the languishing physician-patient relationships inherent in the time limited schedules of primary care today • Even if you do not want to run your own micropractice, there are many tools that micropractices use that can help you with your practice

26. Some things we have been studying are the core attributes of practice that make a difference in outcomes that are meaningful to patients.   (A1c, while all well and good is not a patient outcome - more like "I ended up in the ED or hospital" or "My meds make me sick" or "My life is miserable 'cause I can't do stuff I enjoy.“)There are key practice behaviors and attributes that make immense difference to patients and outcomes:AccessContinuityEfficiencyPatient-centered careCare coordinationWe do most of this (we have room to improve on some components and lots of work to do in care coordination).  We get phenomenal results on our patient reported measures because of how we've set up practices.What we can teach other docs is how to deliver superb care in any practice.  Other physicians may want to do it in a large group (if they get support) or may want to go solo. We don’t want to try to sell docs on going solo but we do want to use our stories to tell how we moved a lot closer to "superb care."  Taking that approach means the discussion applies to all practices - any practice could do this (if the leadership lets them).”

27. Summary of the way we work: • Low overhead begets breathing room Breathing room begets enhanced patient relationships, time to work on processes, and physician satisfaction • Access /efficiency built in • Patient relationship helps measurement • and measurement is feedback • Feedback, real time, continuous, helps improved outcomes

28. Specifically? How to lose your fear and gain control learn to use an emr jedi manual imptechsolution list servs Do billing Measure - HYH Efficiency tools IMH appointment quest , relayhealth, medfusion, up dox and onebox --faxes come in and go out without paper Learn and do open access

30. handy ADL screening prevention up to date Useful patient education links Permission: JH Wasson

31.  Health indicators for my patients Permission: JH Wasson

32. Quality ofcareindicators

33. Summary Low overhead/breathing room Weave access, efficiency and continuity Measure with sophisticated tool (Feedback)

34. An ideal medical practice Quality of care in a vital and sustainable environment

35. jnantonucci@gmail.com • www.Youtube.com search under clemfm and gmoore1960 • Joint Commission Journal on Quality and Patient Safety August 2008 • www.Impcenter.org

36. Why did you go to medical school?