QUALITY IMPROVEMENT RURAL CHALLENGES AND OPPORTUNITIES

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QUALITY IMPROVEMENTRURAL CHALLENGES AND
OPPORTUNITIES

• ORHP GRANTEE PARTNERSHIP
• CONFERENCE
• TOM DEAN MD
• AUGUST 31, 2009

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QUALITY WHAT IS IT?THE THREE A's

• APPROPRIATE
• ACCESSIBLE
• ACCEPTABLE

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QUALITY WHAT IS IT?THE THREE A's

• APPROPRIATE
• CORRECT IN TERMS OF THE BEST SCIENTIFIC EVIDENCE
  WE HAVE

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ALBERT EINSTEIN

• Not everything that counts can be counted, and
  not everything that can be counted counts.

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QUALITY WHAT IS IT?THE THREE A's

• ACCESSIBLE
• FREE OF UNREASONABLE FINANCIAL AND GEOGRAPHIC
  BARRIERS

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QUALITY WHAT IS IT?THE THREE A's

• ACCEPTABLE
• DELIVERED IN A MANNER CONSISTENT WITH THE
  PERSONAL AND CULTURAL VALUES THE PATIENT BRINGS

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STRATEGIES

• SYSTEM BUILDING
• STRONG EMPHASIS ON COORDINATION AND
  COLLABORATION
• BETTER INFORMATION SYSTEMS
• AVAILABILITY OF DECISION SUPPORT AND
  TRACKING OF PATIENTS AS THEY MOVE THROUGH
  DIFFERENT SEGMENTS OF THE HEALTH CARE SYSTEM

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STRATEGIES

• RATIONAL PAYMENT STRUCTURES - EMPHASIS ON
  VALUE NOT VOLUME
• -PAY FOR PERFORMANCE
• CENTRAL ROLE FOR PRIMARY CARE
• - SUPPORT FOR COORDINATION OF CARE
• - MEDICAL HOME

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RURAL IMPLICATIONSA FEW OF MANY!

• SYSTEM BUILDING AND BUNDLING OF PAYMENTS WILL
  PROVIDE INCENTIVES FOR LARGE SYSTEMS TO INVOLVE
  RURAL CLINICIANS
• PAY FOR PERFORMANCE DIFFICULT TO IMPLEMENT IN
  SMALL VOLUME PRACTICES
• RENEWED EMPHASIS ON PRIMARY CARE SHOULD INCREASE
  YOUNG PHYSICIANS INTEREST BUT WILL ALSO INCREASE
  THE COMPETITION IN RECRUITING

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RURAL IMPLICATIONSA FEW OF MANY!

• RECOGNITION OF VALUE OF PRIMARY CARE SHOULD
  PROVIDE MORE RESOURCES FOR RURAL CLINICIANS
• BETTER INFORMATION/TELECOMMUNICATIONS SYSTEMS
  WILL REDUCE ISOLATION

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BRENT JAMES

• MAKE IT EASY TO DO
• THE RIGHT THING!