Recruiting Physicians for PACE

1. Recruiting Physicians for PACE Two Case Studies

2. Case Study: River City The PACE office was contacted by Dr. Harold Hill. Until recently, Dr. Hill was a primary care physician in a large group practice for 18 years in River City. He is a respected physician, who wants to improve the quality of asthma care in his community. In addition, he decided to take time off from clinical practice while he considered other career goals. He is independently wealthy. In the last year he had resigned from his clinic job and had also become a founding member of an asthma coalition.

3. River City (2) He had attended a PACE training session and wanted to set up a seminar in his home city. He was worried about attendance at the seminar since he knew physicians in his community were not very interested about asthma. As a result, he arranged for CME credit to be given at the PACE seminar as well as a nice dinner ($70/plate) at an exclusive restaurant. Costs are sponsored by asthma coalition funds. In addition to recruiting a well known local pulmonologist and health educator as part of the seminar faculty team, he personally contacted and visited all 19 pediatric practices in the community to recruit physicians to attend the PACE seminar.

4. River City (3) Initially many physicians were skeptical about “another CME dinner.” He left short notes at each practice one month, one week and one day before the seminar. He distributed articles about the impact of the seminar on other communities. Dr. Hill’s former clinic boss had openly discouraged physicians from his former clinic to attend the PACE seminar. Despite this set back, due to the “buzz” that he had created about the seminar, he received numerous last minute calls from other physicians outside his specialty, nurse practitioners and allied health professionals to attend the seminar. Some physicians wanted to bring their spouses.

5. River City (4) The asthma coalition had been trying to raise interest in the coalition among practicing physicians and the coalition was hesitant to turn down physicians. The coalition predicted a modest turnout. However, instead of the expected 11 attendees, there were 20 attendees. The additional costs were significant. Participation among the physicians was good, but uneven at times. Some physicians did not speak up during the discussion unless Dr. Hill called on them by name.

6. Questions • What were some of the positive aspects of the River City physician recruitment strategy? • Which of these strategies are practical for your asthma coalition to incorporate to recruit physicians to attend the seminar? • What were some of the negative aspects of the River City physician recruitment strategy? • Which of these strategies can your asthma coalition avoid when recruiting physicians to attend the seminar?

7. Case Study: Statewide MCO The PACE office was contacted by the medical director, Dr.Smith, of Statewide Managed Care Organization (S-MCO). S-MCO is a traditional managed care organization with a network of over 2000 providers in urban and suburban settings. Dr. Smith is concerned about the most recent HEDIS measures for asthma care which suggest that only 38% of their pediatric patients with persistent asthma are prescribed a controller medication by their primary care physician. Dr. Smith is aware of the PACE seminar and knows that part of the curriculum includes a review of the NHLBI guidelines for use of controller medication.

8. S-MCO (2) He is aware that the major focus of the seminar is physician asthma education. Dr. Smith agrees to sponsor the PACE seminar for his member physicians. He would like the physicians, especially the physicians with low HEDIS ratings to attend the seminar within the next 2 months. Instead of a train-in-trainer session for a group of physician leaders within S-MCO, he hires well-known, nationally respected physicians from the state medical school to run the seminar. He develops a list of physicians that he believes would benefit from the PACE seminar.

9. S-MCO (3) From this list, he personally calls each physician. Dr. Smith invites the physicians to attend the PACE seminar. He tells each of the physicians that he will also be attending the seminar as well. The seminar is held on weekday nights at the Statewide-MCO Board Room, which is centrally located. A modest dinner and CME credits are provided. During the planning of the PACE seminar, Dr. Smith requests that the “Documentation, Coding, and Reimbursement” module not be included in the seminar.

10. S-MCO(4) Dr. Smith has the S-MCO office staff send reminder letters about the seminar. Although some physicians are up to 30 minutes late, all the providers attend the PACE seminar. Attendance is 100%. The discussion during the seminar is very productive. During the discussion, several primary care physicians point out that their patients have not been receiving spacers for their inhalers since S-MCO does not “pay” for spacers. Dr. Smith had not been aware of this issue and plans to address this reimbursement issue. Dr. Smith is also able to announce a new quality improvement initiative to send HEDIS utilization summaries for the charts of all its members.

11. S-MCO Case Study (5) He is able to get some feedback regarding the format of the utilization summary. During the PACE seminar, only half of the participants are active. Three of the 12 physicians do not participate in the discussion. All physicians stay until the end of the presentation.

12. Questions • What were some of the positive aspects of the S-MCO physician recruitment strategy? • Which of these strategies are practical for your asthma coalition to incorporate to recruit physicians to attend the seminar? • What were some of the negative aspects of the S-MCO physician recruitment strategy? • Which of these strategies can your asthma coalition avoid when recruiting physicians to attend the seminar?

13. Notes for River City Case Study Positive aspects to discuss Importance of a local “champion” who is aware of local customs and attitudes Personal contact/recruitment by a well-respected member of the physician community Aggressive and repeated contact CME credits provided Expensive dinner to attract physicians Use of published studies that support the effectiveness of the program Use of local, well-known experts as faculty Co-sponsorship with local organization Flexibility to incorporate last-minute attendees Negative aspects to discuss Dr. Hill is unique; Not all coalitions have a physician that can devote 100% of time to recruitment Designation of a local “champion” is subjective and can be a negative (one clinic did not send any doctors) Expensive dinner (physicians may attend just for a free dinner at an expensive restaurant) No pre-established policies for attendance (limited number of places, no spouses, physicians only?, etc.) Too many physicians at seminar can inhibit discussion. It is difficult to involve more 20 people in a discussion.

14. Notes for S-MCO Case Study Positive aspects to discuss Importance of a “champion” medical director Involvement of MCO organization & staff resources Targeted recruitment of physicians that would otherwise not attend an asthma CME event. Personal contact from the medical director. Medical director states that he will also attend the seminar. Dinner and CME credits Presence of medical director at the PACE seminar allowed an open and frank discussion about S-MCO’s policies for covering durable medical equipment, including spacer devices Medical director had opportunity to discuss other quality improvement initiatives and receive director provider feedback. Negative aspects to discuss Medical Director’s agenda may not directly match the goals of the seminar (HEDIS controller measures versus improving physician asthma care education) The “trainers” are not part of local physician community. There are still no local physicians who are designated trainers that can train other physicians in the community. Hiring outside faculty can be expensive. Less flexibility with curriculum--cannot include the “documentation, coding and reimbursement” module Physicians may have felt “obliged” to attend out of courtesy to medical director. The presence of uninterested and inactive attendees may affect the dynamic of the discussion.

15. Final Points • Link the seminar with a well-known opinion leader • Use repeated and personal contact • Meal and CME are usually expected • Establish invitation limits early • Specialty-specific • Physician-specific • Rules about spouses and significant others • Anticipate that some physicians may not attend • 10-12 physicians is optimal