Planning Your Practice Future

Do you have goals for your practice? Do you have a strategic plan to help you reach your goals? Or does your practice have no aims, instead reacting to challenges as they arise, often wasting a great deal of time and effort? I believe that it is much better to plan. You are more likely to have firm goals in mind and are more likely to reach them. Also, with the experience of creating and executing plans, you are more likely to be able to handle unexpected challenges adroitly. As Nick Fabrizio stated in the article “Strategic Planning Gives Clear Direction” on ModernHealthcare.com September 2012, “Effective strategic planning will help prepare physicians and their medical groups for the myriad changes expected in tomorrow’s healthcare environment.”

Strategic plans, no matter what the business, have several common features. Most begin with a vision statement. For instance: Provide quality healthcare with a lower cost. This happens to be the number one challenge of healthcare providers according to a 2013 Medical Group Management survey. I believe that being patient-centered, providing quality care efficiently and improving the bottom line is a good vision for a practice.

Vision statements are very broad. Your strategic plan must include some details of what actions you need to take to reach your vision. The vision statement of a practice will remain stable from year to year but the actions will need to change every two to three years. In order to remain flexible to the changing environment of providing quality care strategic plans should be created to last two to three years. In the past strategic plans were written to last five or more years. The rapid changes occurring in all businesses require that strategic plans have a shorter life.

What might be some actions that could be undertaken to provide care that is patient-centered, efficient while providing high quality, and improving the bottom line? One path to improve being patient-centered is to improve communication between physician and patient, helping the patient to set his own goals for his care. Improved communication between other clinical providers and office staff also improves patient-centered care. Care that is more patient-centered is usually more cost efficient and leads to improved income for a practice. This has been shown in studies of patient-centered medical homes, one pathway to improvement in being patient-centered.

A path to improvement in efficiency, a part of my suggested vision statement, is upgrades in health information technology. It will be necessary to update practice management software and other HIT in a practice in the coming year to accommodate ICD-10 coding. With the new coding, practices will be better able to manage care at the population level, which will keep patients with chronic diseases healthier. Managing care at the population level is more effective, efficient and of higher quality.

Who should be involved in creating a strategic plan? According to the article “Reduce Healthcare Costs without Sacrificing Quality and Flexibility” in the March 2014 issue of MGMA Connection those involved vary by practice size, culture, management style and structure. “Team representatives could include an administrator, a physician, a clinician, information technology, and administrative support,” according to the article.

As stated earlier, strategic plans should have a life of two to three years. After writing yours, be sure to make sure all of your employees are familiar with it and understand it so that they can be effective in helping the practice implement it. I would recommend that practices review their strategic plan three or four times a year so that physicians and staff will keep the goals of the vision statement in mind.

After a team has created a strategic plan it will be necessary to create annual implementation plans that detail how the practice is to achieve the goals set forth in the strategic plan. Implementation plans contain specific actions, who is responsible for seeing that the actions are completed, by what date the action will be completed and what indicators will be used to measure how effective the actions were in achieving the goals.

Presently I am working with a health department in developing an implantation plan for the coming fiscal year. One of the goals is to provide better community integration of prevention and treatment services for those with substance use disorders. Thus, one of the first actions could be to have a member of the heath department’s prevention team make contact with the primary care providers in the county by either mail or personal contact to provide information to the PCP about screening for substance misuse and to see how the health department can support the PCP in this effort. The implementation plan could set a nine-month goal of reaching out to 50% of the primary care providers in the county, as recorded in a spreadsheet.

I believe that actions detailed in an implementation plan are best carried out by a team using a well-defined strategy. For instance, if the action is to prepare a practice for the use of ICD-10 coding it will be necessary to use a team to oversee the details of the implementation of a plan to ready the practice for its use. The plan could use a Plan-Do-Check-Act strategy to be sure that coding staff and clinicians understand ICD-10 well, that HIT is upgraded and tested, that sufficient resources are set aside to cover the costs of it implementation and that communication about the implementation to all staff is effective. Results of the measurement phase of the strategy should be reported regularly to those overseeing the strategic plan.

Practices usually fall into one of three categories in regard to strategic plans. One, the practice does not have a strategic plan and reacts ineffectively and inefficiently to new problems and challenges. Two, the practice creates a strategic plan and then shelves it, never bothering to review it until the time arrives for creating a new one. Three, a practice creates a strategic plan and reviews it regularly to make sure the implementation plan is working towards achieving the goals set forth in the plan. Those who fall into this third category usually find their work much more satisfying and rewarding.

The Features To Look For When Investing In An Electronic Medical Record System

Keeping accurate and up-to-date medical records for a large number of patients can be the bane of any medical practitioner’s life. Not only are these professionals tasked with attending to the needs of many different patients each and every day, but the additional administrative duties that need to be fulfilled are often time-consuming and arduous.

The invention of the electronic patient record system has meant that it is now easier than ever before for doctors to handle this kind of task. There are many benefits to this type of system, including saved time, a positive impact on doctor-patient relationships, increased productivity at the medical practice and much, much more.

When selecting an electronic medical record system to implement in a doctor’s practice, however, there are a few particular features to look out for that can be particularly advantageous. Whereas it is true that there are many great options on the market of this kind of system, each one has its own merits and downfalls, and each one will have distinct differences.

The first thing to look for is an electronic patient record that keeps an accurate record of patient data over time. This is vital as it will provide at a glance not only the most recent information about the patient that has been entered into the system, but also will show up any major changes or developments in the health of the individual.

Ideally, this information should be presented in a format that is both quick to read and easy to understand. When bringing up this information on a computer during an appointment with a patient, it is vital that time is not wasted trawling through large volumes of data to find the information needed.

Instead, a good electronic patient record system will make all the necessary data easily accessible in order for the doctor to draw relevant information from it. When choosing a system, care should be taken to verify that this usability is present in the software and that medical practitioners at the particular practice will find it easy to use.

Secondly, look for a system that does not require excellent penmanship. Whereas writing out information clearly and legibly by hand can be a long and sometimes arduous process – and can result in errors – a good system will allow information to be entered easily with basic typing skills.

Some record systems will also have shortcuts that will also make data input much easier. This means that all staff can quickly and easily update the records as and when they need to. All the data is centralized too, meaning all members of staff at the practice can view it as and when they need to.

It is beneficial to also look for a record system that sends alerts and reminders for when a particular patient needs to attend preventive visits, vaccinations and screenings. This can also show missed appointments and missed screenings, which again makes sure that nothing is forgotten and that patients receive the highest standard of care and attention.

Lastly, a good electronic patient record system will make sure that a patient’s vitals are also monitored to track changes in health over an extended period of time. Information that can be included on these records can comprise blood pressure, vaccinations, temperature and much more.

All of these features can be considered essential in order to get the most out of your new electronic medical record system. It is therefore worth looking for these specifically if you decide to invest in such a system for your medical practice. In addition to those listed above, search for features that you believe will benefit you, your staff and your patients.

Sources of Change

Some of us are very comfortable with change. For others, change is unwelcome and causes a great deal of anxiety. Organizations are very similar, I believe. I have read many postings and articles on healthcare sites about the stresses caused by the mandated changes in healthcare. Too, politicians love to rail against a wide variety of changes, especially if the politician is in the minority party at the time.

Change is a constant for organizations and for humans. Some changes are forced upon us, as the Physician Quality Reporting System (PQRS) is mandatory for those who provide Medicare Part B services and as buying healthcare insurance is for adults in the U.S. Other changes are voluntarily adopted by organizations to improve their services and products. An example for organizations is a group of healthcare providers becoming an accountable care organization (ACO). Many individuals want to lose weight. Not all are successful.

I believe that resisting change is unhealthy, for both businesses and individuals. Not responding to mandated changes can be costly. Individuals who do not buy health insurance face a tax penalty. Providers who do not strive to provide the best care, to excel at patient engagement, may lose patients to their competition.

Let us look at some organizational changes and their consequences.

This is a very critical year for providers involved in the PQRS program. Reporting in 2014 for eligible professionals is required by CMS or in 2016 reimbursements will be reduced by 2%. This can have a significant impact on providers who have a high proportion of Medicare or Medicaid clients. Those who are successful in reporting will receive a 0.5% bonus on their Part B Fee Schedule. The Medical Group Management Association (MGMA) provides an easy to use reference for its members that guides providers and staff through the steps of providing CMS with the necessary information to avoid the penalty in 2016. It lists four steps with links to resources necessary to finish each step:

1. Determine if you are an eligible professional (EP)

2. Determine if you will report on individual measures or a group of measures

3. Choose your registry from the approved list on the CMS site

4. Use the reporting wizard in your registry to report the data to CMS

Hopefully, you already are using a registry that is approved by CMS.

There are several other mandatory programs that require major changes and challenges for providers in the coming year. Two of these are reporting on meaningful use stage 2 for electronic health records (EHR’s) and preparing for the switch to ICD-10. Of these three, I believe that the most challenging and most important is the switch to ICD-10 coding as it can be very costly not to be ready on October 1, 2015.

As noted above, some organizations decide to make major changes in order to improve their services or their products. Healthcare groups are reorganizing as they look forward to changing reimbursement patterns. Two of these reorganizations styles are patient-centered medical homes (PCMH) and accountable care organizations (ACO). Both organizational styles focus on improving the quality of outcomes while cutting costs to payers and becoming more patient-centered. Both organizational styles can reap significant rewards from payers if they are effective.

In the November 2013 edition of HealthLeaders various executives of provider groups reviewed their moves to adopt population level health analytics to improve the outcomes of their ACO’s and, thus, improve the likelihood of sharing in any savings to the payer. Aric Sharpe, vice president of UnityPoint Health, an ACO in West Des Moines, Iowa, stated that, “We felt it necessary to build a platform where we can mesh together both claims data and data out of our electronic health records, because there’s a lot more that’s able to be learned in that type of environment.”

Reorganizing to become an ACO or a PCMH is usually a decision made by executives along with their governing boards. The implementation of the reorganization is based upon documents detailing structures and goals agreed upon by payer or national organization and provider. The changes are driven from the top levels of the organization. A few very effective organizations also drive continuous change from the bottom up. That is, they take suggestions from front-line staff to improve services by making changes that are usually small and incremental. If an organization seriously undertakes to implement most of the suggestions that can be seen to improve quality (I know one organization that implemented 95% of the suggestions from front-line staff) the cumulative outcome can greatly improve patient or client satisfaction and care and improve the bottom line.

In the May/June 2014 issue of MGMA Connection in the article “As Payers and Government Push for Quality Care, Staff Motivation and Goals Must Change” Jennifer Gasperini, a senior representative of the MGMA Government Affairs body stated that CMS has expanded PQRS reporting and the Value Based Payment Modifier (VBPM) over the past two years. Further, she states that, “We can expect that trend to continue in the near-term future, particularly with regard to VBPM, which will affect all physicians beginning in 2017.”

Intermountain Healthcare in Salt Lake City takes this statement seriously. It is using clinical groups to identify disease areas for clinical focus. It then uses a Lean Six Sigma approach to drive improvements. It has trained over 900 of its over 3000 employees in this continuous quality improvement approach. Quality efforts are team based. Data is regularly collected on identified metrics. The measurement results are regularly reported back to the staff in order to improve outcomes even more by making adjustments to improvement strategies as needed.

I am presently involved in creating an implementation plan for the coming fiscal year at a nearby health department. The drive to improve the quality of the programs used to prevent the use of tobacco and drugs by individuals in the county is being led by members of a workgroup committee that is comprised of staff of the health department and by community members. One focus of the new implementation plan is to improve the monitoring of the outcomes by using an expanded set of quality indicators.

Bob Dylan was right when he sang The Times They Are A-Chanin’. The next few years will see significant changes in healthcare. Some of these changes will be demanded by bodies external to the providers. The best providers will adapt to these demands as well as creatively foster change from within. These organizations will reap the benefits of improved patient satisfaction, improved patient outcomes and a much better bottom line.