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The Medical Professionalism Blog

Hope is On the Way for Primary Care Practice

At a March 12 conference sponsored by the ABIM Foundation, we heard descriptions on how primary care can and should be improved to:

Thirteen clinicians and physicians shared innovations they implemented in their practice that improved the quality of care they provide and made them happier as physicians providing it. Their innovations were straightforward, simple to implement with high impact on work flow and included appropriate distribution of tasks and engaged patients in their care such as:

  • “scribing” by trained professions into the electronic medical records;
  • improved teamwork and
  • co-location of clinicians to improve communication.

Others were more complex and required some — but not extravagant — additional resources.

Many attendees at this conference were young leaders in the medical profession –medical students, residents and young faculty. They seem determined to build clinical environments that are more supportive of patients and physicians. They are less tolerant of the chaotic practice; they know there are better ways to deliver primary care. They spoke about mastery and control of the practice to better serve their patients and promote the well-being of clinicians.

At the end of the day, participants discussed what is needed to help primary care physicians make the transformation to a joyful, productive and patient-centered practice. This is what they said:

1) Practices need technical assistance to learn how to implement best practices like those presented at this meeting. Leading innovators are eager to share and provide advice about the technical aspects of their implementations, and several have set up “institutes” to be able to fulfill such requests. Hosting such a service is not without costs, however. Many smaller practices and other resource-poor practices need financial support to get this technical assistance and would benefit from subsidies to either themselves or the sponsors on their behalf in order to cover the costs of any fees the “institutes” may require.

2) There is a need to develop tool kits and audio/visual imagery that tells the story of this transformation journey. The most powerful way to engage physicians in the journey is to have patients and physicians talk about what the results of the transformation have meant to them.

3) Practices need resources above and beyond normal operating revenues at the beginning of their transformation to implement necessary changes in staffing, structure and process. While many of these innovations are low costs to begin with, some high-impact innovations require more personnel, facility renovations or enhanced administrative systems. In a fee-for-service environment, many of these innovations quickly result in higher productivity and higher revenues. However, as practices transition from fee-for-service reimbursement into larger systems that embrace global payments, the return on investment will require a different accounting, and also will take longer. Nevertheless, if they are to achieve their population health goals, these systems will need to devote a portion of their global payment to enhancing the infrastructure of their primary care practices,

4) Accreditation systems of patient-centered medical homes should not just recognize the need for more functions to be placed within primary care, they must also understand how those functions should be distributed among the team of clinicians and non-clinicians.

5) Practices need to produce higher value services, not just more visits. Payers and purchasers need to recognize this value. It is estimated that even though primary care is estimated to be five percent of health care expenses, it can have a significant impact on the other 95 percent of the national health care spend.

6) New and bold innovations should be tested and supported by third parties. We stand on the verge of rapid change and innovations in primary care. Those who can support clinical practices, such as foundations, payers/purchasers and government, must now step up to the plate.

1 Comment to Hope is On the Way for Primary Care Practice

  • Marc S Frager's Gravatar Marc S Frager
    March 22, 2012 at 6:56 pm | Permalink

    I would love to see the ABIM foundation reply to DrRich at the covertrationingblog.com. He has a most incisive take on “professionalism” and the “new ethics” promulgated by the ACP and ABIM foundation. Please see especially his chapter 3 “the cowing of the medical profession.” That analysis of “professionalism” seems to be especially relevant and realistic.

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