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IdealMicroPractices IdealMedicalPractices

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Title: 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

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

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.

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

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

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

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).

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

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