IdealMicroPractices IdealMedicalPractices

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IdealMicroPracticesIdealMedicalPractices

• Jean Antonucci MD

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Micropractice

• An Emerging model of Care

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• 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

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• Crossing the Quality Chasm
• Radical redesign of the system needed
• 6 aims
• Safety
• Timeliness
• Efficiency
• Effective
• Equitable
• Patient centered collaborative care

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• 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.

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

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What Is An 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

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

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• 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 Physicians
  Foundation for Health Excellence and the
  Commonwealth Fund

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

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TOOLS

• Low overhead
• EMR
• Access
• Continuity
• Small functional units (efficiency)
• HowsYourHealth.org (measuring stick)

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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/jo
  urnals/fpm.html Authors Moore, Ho, Eads, Guinn

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WHY PHYSICIANS CHOOSE MICROPRACTICE

• --Physician satisfaction
• Absolute autonomy
• Zero practice inertia
• No practice administrators
• SATISFACTION WITH QUALITY OF PATIENT-PHYSICIAN
  INTERACTION

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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

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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
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• 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

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• One thing 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
  outcomesAccessContinuityEfficiencyPatient-cen
  tered careCare coordinationWe do most of this
  (we have room to improve on some of the
  patient-centered 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 practice.What we can teach
  other docs is how to deliver superb care in any
  practice.  Another physician may want to do it in
  a large group (if they get support) or may want
  to go solo.  I don't think we want to try to sell
  docs on going solo but 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).

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• Summary of the way we work
• Low overhead begets breathing room
• Breathing room begets enhanced patient
  relationships and physician satisfaction
• Patient relationship helps Measurement
• and measurement is feedback
• which helps beget improved outcomes

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

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handy ADL screening
prevention up to date
Useful patient education links
Permission JH Wasson
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? Health indicators for my patients Quality of
care indicators for my practice
?
Permission JH Wasson
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Summary

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

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

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

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• Why did you go to medical school?