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Physician Practice Redesign Essentials: A Transformation Roadmap
Physician Practice Redesign Essentials: A Transformation Roadmap
Physician Practice Redesign Essentials: A Transformation Roadmap
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Faced with emerging reimbursement models that focus on patient outcomes and demands for increased reporting of adherence to evidence-based guidelines, physician practices are being forced to transform the way they operate, from practice workflow to patient encounters to patient and condition tracking.

In “Physician Practice Redesign Essentials: A Transformation Roadmap,” a four-volume set, you’ll get the essential steps physician practices need to take to succeed in this environment. You’ll learn from leading practice transformation experts on adopting a culture of change, choosing a physician performance measurement set, using flowcharts, checklists and diagrams, increasing practice revenue through PQRI, creating actionable information on patient needs and driving improvements in outcomes for patients and practices.

This four-volume set includes:

Physician Practice Transformation Toolkit: 29 Simple Ways to Succeed in Quality Care Management

Many forces are combining to create the perfect storm in primary care — a predicted PCP shortage, a preference for patient-centered models of care, rejection of traditional reimbursement models, increased quality and reporting demands and health IT edicts. With EHRs and the medical home model on the horizon, there's no better time for physician practices to take stock of current workflows and prepare for the new face of primary care. Physician Practice Transformation Toolkit: 29 Simple Ways to Succeed in Quality Care Management offers tested strategies, tools and processes from physician thought leaders who have guided practices through the transformation process.

Even without sophisticated technology, physician practices can make slight adjustments in culture and workflows that contribute to a sea change of improvements in practice efficiency, performance measurement and patient outcomes.

In this 44-page special report, physician thought leaders who have already retooled physician practices share 29 key strategies that can set the stage for a practice that can easily participate in and profit from emerging reimbursement strategies, including pay-for-performance programs and the patient-centered medical home.

Providing a detailed roadmap to improved care management by physician practices are contributing authors Lonnie E. Fuller Jr., M.D., medical director for the Pennsylvania Medicaid ACCESS Plus Primary Care Case Management Disease Management Program, John Michos, M.D., medical director of the Virginia Health Quality Center and Bruce Bagley, M.D., medical director of quality improvement with the American Academy of Family Physicians, which represents more than 100,000 physicians and medical students. Besides providing 29 pointers for practice transformation, these contributing authors share details on:

  • Rewriting the roles of physician practice team members;
  • Understanding the psychology inherent in the practice culture;
  • Using existing resources to sharpen a practice's organizational skills;
  • Improving data collection — with or without an EHR;
  • A range of quality improvement tools — spreadsheetsheets, flow charts and templates — to help practices map and improve process flow;
  • Moving a transformed practice toward the medical home model;
  • Sustaining and measuring change in the practice environment;
and much, much more, including eight pages of related Q&A and six pages of relevant links and resources to support the 29 strategies offered in this special report.

Table of Contents

  • Physician Practice Transformation: Talking about Change
    • Cost of Care in America
    • Champion for Change
    • Financial Support
    • Practice Transformation Skills
    • Implementing Workflow Change
    • Transformation Challenges
    • Celebrate Failures as Lessons Learned
    • The Ups and Downs of Physician Culture
    • Change Doesn’t Happen Overnight
    • No Pain, No Gain
  • Emphasizing Quality in Practice Transformation
    • Why Transform Your Culture?
    • Transforming Chronic DM
    • Assessing Readiness-to-Change
    • Care Management Road Map
    • Measuring Physician Performance
    • Establishing Patient Goals
    • Average PCP Visit
    • Implementing Change in the Workflow
    • Sustaining Improvement & Monitoring Progress
  • Q&A: Ask the Experts
    • Physician Practice Transformation and Costs
    • Telemedicine Usage Increases in Healthcare
    • Practice Transformation and Health IT
    • Starting Point for Practice Transformation
    • Cultural Change and Transformation
    • Patient Demographic Affects Transformation
    • Tackling Chronic Conditions During Practice Transformation
    • Solutions to Maintaining Patient Registries
    • Re-evaluating Processes After Transformation
    • Evident Changes after a Practice Transformation
    • Measuring Patient Satisfaction
    • Physician Practices Becoming Medical Homes
    • Impacts of Medical Home Demonstration Pilot
    • Accomplishing Workflow Changes
  • Glossary
  • For More Information
  • About the Authors

Simple Steps to a Patient Registry: Ticket to Care Coordination, Quality Reporting and Pay for Performance

Patient registries at the physician level provide health plans, providers and disease management programs with a more accurate picture of the patient experience — individually or as a population. The patient registry is a cornerstone of Edward Wagner's chronic care model, the foundation of the patient-centered medical home (PCMH) and practically a prerequisite for participation in quality measurement and pay-for-performance (PFP) initiatives.

"Simple Steps to a Patient Registry: Ticket to Care Coordination, Quality Reporting and Pay for Performance" illustrates how even the solo practitioner can simply and inexpensively implement a population-based registry that provides actionable information on patient needs. From a set of index cards in a shoebox to a clinical information system auto-populated from an electronic medical record, the patient registry guides the entire care team in the management of chronic illness and preventive care. Registries also have been shown to decrease per-member costs and reduce hospital admissions.

In this 25-page report, physician practices, health plans and quality organizations describe how they use patient registries to improve care coordination and compliance with preventive care, respond to ever-expanding external demands for data and prepare for the eventual transformation to a medical home. This report is based on survey responses from 159 healthcare organizations, in-depth interviews with existing users of patient registries, analysis of Web-based patient registry tools and resources and advice from industry thought leaders on the application of patient registries to the PCMH and physician quality improvement initiatives.

This report provides details on:

  • Who's using patient registries to measure quality and performance on key health outcomes;
  • The challenges and benefits of implementing a registry and its impact on patient satisfaction, compliance and preventive care;
  • From registry to reporting — why registry use facilitates participation in PQRI and other quality and PFP initiatives;
  • Suggested formats for patient registries;
  • Sources for free and low-cost patient registry templates, support materials and implementation support;
  • Training the care team in registry use and overcoming barriers to implementation;
  • Supplementing registries with underutilized/untapped data;
and much more.

Additionally, two diverse organizations share their stories of patient registry adoption and use — Upper Peninsula Health Plan, a consumer-centered, provider service organization of physicians, hospitals, clinics and ancillary providers; and the Wisconsin Collaborative for Healthcare Quality, a voluntary consortium of physician groups, hospitals and health plans.

Health Coaching in Primary Care: Persuading Physicians to Prescribe Behavior Change and Self-Efficacy

Relationships are important in healthcare — perhaps none more so than the physician-patient bond. Until now, these encounters have largely been focused on treating illness, not preventing it. But as healthcare acknowledges the clinical and cost benefits from health coaching in disease and health management, some experts say that primary care is ripe for the same change. In addition to dispensing clinical advice, it may also be time for primary care physicians (PCPs) to prescribe physical activity, smoking cessation and other healthy habits to guide patients toward self-efficacy.

In this special report, "Health Coaching in Primary Care: Persuading Physicians to Prescribe Behavior Change and Self-Efficacy," three health coaching thought leaders detail their models for incorporating health coaching into the primary care paradigm. While acknowledging existing demands on busy physicians, they recommend that PCPs school themselves in health promotion and make coaching a team effort to foster behavior change in members and patients.

But for this effort to be successful, physicians need a dose of their own medicine, embracing healthy habits themselves — "walking the walk" so they can effectively "talk the talk" with patients.

In this 41-page special report, contributing authors Dr. Rick Botelho, professor of family medicine at the URMC Family Medicine Center, Margaret Moore, CEO, Wellcoaches Corporation and Dr. Edward Phillips, director of outpatient medical services at Spaulding Rehabilitation Hospital Network and assistant professor of the Department of Physical Medicine and Rehabilitation at Harvard Medical School, describe how to leverage the trusted clinician relationship to reinforce behavior change. They provide details on:

  • Moving practitioners from "fixers" to "motivators";
  • Why healthy physicians don't automatically make the best coaches;
  • Teaching physicians to "walk the walk" and "talk the talk" without alienating patients;
  • Implementing blended learning methods to support a team approach to health coaching;
  • The 10 common mistakes health plans and disease management organizations make and 10 strategies to correct them;
  • Developing a culture of health promotion in a physician practice and the training effort to support it;
  • Two physician-training initiatives aimed at improving health promotion and disease prevention by physicians;
  • Rudiments of a Lifestyle Clinic;
and much more.
2008 Physician Quality Reporting Guide: Essentials of Data Collection, Work Flow Optimization and Physician Engagement for Practices

Many physician practices are gearing up for a full year of participation in The Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting Initiative (PQRI), now in its third year. While participation in PQRI is voluntary for now, many health plans are modeling their own quality reporting and physician reimbursement processes processes on this CMS initiative. Eventual mandatory participation in PQRI is expected, as is PQRI’s impact on traditional physician reimbursement models.

This special report, 2008 Physician Quality Reporting Guide: Essentials of Data Collection, Work Flow Optimization and Physician Engagement for Practices, introduces the 2008 PQRI changes and offers strategies and templates to optimize practice work flow and turn PQRI participation into profit. From the perspectives of the physician, administrator and coder, three thought leaders in the quality and measures reporting arenas describe how to streamline data collection, overcome barriers to staff and physician participation and monetize the measures to increase physician practice revenue streams while enhancing patient care. Even for practices who have not yet adopted electronic medical records, it is still advantageous to participate in PQRI, these experts say. This special report provides a range of Web-based PQRI resources and tools to enhance participation.

In this 35-page report, you'll get invaluable suggestions for work flow improvement, from the pre-office visit process to tasks performed by the physician, back office and coder. Contributing authors Dr. Bruce Bagley, medical director of quality improvement with the American Academy of Family Physicians, which represents more than 100,000 physicians and medical students; Sue Kincer, consultant and certified professional coder with Pershing Yoakley & Associates, P.C.; and Lorraine K. Larrance, consulting senior manager with Pershing Yoakley & Associates,P.C., share details on:

  • What's new in 2008 — new and retired measures and emerging opportunities for non-physicians to participate
  • The "new money" rewards of PQRI and revenue enhancement strategies
  • Insider coding essentials and tips
  • Cultivating the PQRI practice champion
  • Overcoming the four key barriers to physician participation
  • Automating data collection — with or without an EHR
  • Leveraging PQRI participation for other quality programs
  • and much, much more, including five pages of valuable PQRI process improvement tools, worksheets and resources to enhance physician practice reporting efficiency.

Table of Contents

  • Redesigning Work Flow for a New Physician Payment Environment
    • Measures Development, Endorsement and Implementation
    • Increasing Revenue Using PQRI
    • Common Misunderstandings About Clinical Measures
    • PQRI and Physician Payment
    • Why Participate in PQRI
  • Making a Case for Physician PQRI Participation
    • Four Barriers to Physician Participation in PQRI
    • Reducing Physician Resistance to Change
    • Engaging Physicians in a New Process
  • Essentials of an Effective PQRI Practice Team
    • Guidelines for Measures Selection
    • Work Flow Modifications
    • Confidential PQRI Feedback Reports
    • PQRI Coding Principles
    • Sample Review Steps for Work Flow Process
  • Q&A: Ask the Experts
    • Measures for Podiatrists
    • NPI vs. Tax ID Number Use in PQRI
    • Most-Reported Measures
    • Factoring in Patient Refusal
    • When to Perform Measures During Patient Visits
    • Bonus Payments for 2007
    • Getting Physicians on Board
    • Cultivating Practice Champions
  • Appendix: Sample PQRI Work Flow Process Review Tool
  • Glossary
  • For More Information
  • About the Authors
  • Publication Date: October 2008
    Number of Pages: 145
    ISBN 10: 1-934647-54-3 (Print version); 1-934647-55-1 (PDF version)
    ISBN 13: 978-1-934647-54-7 (Print version); 978-1-934647-55-4 (PDF version)
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