overview of pcmh john bender, md, miramont family medicine patient h. richard brack & his wife...
TRANSCRIPT
OVERVIEW OF PCMHJOHN BENDER, MD, MIRAMONT FAMILY MEDICINEPATIENT H. RICHARD BRACK & HIS WIFE DEBBIE BRACK
10:00 AM
OVERVIEW OF PCMH- AN XTREME MAKEOVER
From the Patient and Physician PerspectivePresented by John L Bender, M.D., FAAFPJanuary 9th, 2014Colorado PCPCC, Denver
Our story begins….
2002 in Fort Collins Colorado….2002 H.G. Carlson, M.D.
• One of the oldest practices in Fort Collins• Open 8-5 most days• Paper Charts• One Employee• One Computer (386)• 1000 patients
In a basement, paneling on the walls
Walls of Paper Charts
Move that Bus!!!
Our story today…
2014 in Colorado….• 7 locations in 6 separate communities (Urban, Suburban, Rural,
and Frontier)• Open M-F 8-8, Saturdays 9-1• 22 providers (11 physicians)• 75 employees• Electronic Charts, Patient Portal, NCQA III PCMH recognition• Over 100 company computers operating in a terminal service
environment and a centralized data center• 35,000 patients• Davies Ambulatory Award recognition from HiMSS in 2010
4th fastest growing company in Northern Colorado
Miramont’s Growth Curve
year receipts volume2001 $169,000.002002 313,565.002003 428,876.002004 494,264.002005 559,110.002006 845,298.002007 1,449,348.002008 1,940,499.002009 2,616,000.002010 3,505,440.002011 4,356,230.002012 4,804,885.00
Miramont's Growth as measured by receipts
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
4,000,000
4,500,000
5,000,000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
year receipts volume
2001 $169,000.00
2002 313,565.00
2003 428,876.00
2004 494,264.00
2005 559,110.00
2006 845,298.00
2007 1,449,348.00
2008 1,940,499.00
2009 2,616,000.00
2010 3,505,440.00
2011 4,356,230.00
2012 4,804,885.00
2010 HIMSS
Ambulatory Award
2011 Colorado PCMH of the Year
34 primary care physicians leave practice during the same time
specialty genderyear of
transitionpractice zip
code eventFamily Medicine female 2001 80524 closed/unable to service debtFamily Medicine male 2001 80524Family Medicine male 2002 80524 moved to work for OrthopedistsFamily Medicine male 2002 80536 closed/unable to service debtFamily Medicine male 2003 80524 sudden death, age 52Internal Medicine male 2002 80524 sold/less profitableInternal Medicine male 2004 80524 sold/less profitableFamily Medicine male 2004 80524 sold/less profitableInternal Medicine male 2004 80524 sold/less profitableFamily Medicine female 2006 80524 closed/unable to service debtFamily Medicine female 2006 80524 closed/unable to service debtFamily Medicine male 2006 80550 closed/unable to service debtFamily Medicine female 2007 80526 closed/unable to service debtInternal Medicine male 2007 80524 sold/less profitableFamily Medicine female 2007 80550 closed/unable to service debtFamily Medicine male 2007 80537 closed/?Internal Medicine male 2007 80537 closed/moved to BTMGFamily Medicine female 2003 80526 I can not disclose under contractGynecology male 2005 80524 closed/divorce?OB/Gyn female 2003 80528 ?OB/Gyn female 2003 80528 ?Family Medicine female 2002 80524 ?OB/Gyn female 2002 80524 ?Family Medicine male 2008 80528 unable to service debtFamily Medicine male 2008 80521 uncertainFamily Medicine male 2008 80521 offered job in Sports MedicineFamily Medicine male 2008 80524 sold/less profitableInternal Medicine female 2008 80524Internal Medicine male 2008 80524 sold/less profitableFamily Medicine male 2008 80549 closed by CRMC, non profitable
8 are bankruptcies…
specialty genderyear of
transitionpractice zip
code eventFamily Medicine female 2001 80524 closed/unable to service debtFamily Medicine male 2001 80524Family Medicine male 2002 80524 moved to work for OrthopedistsFamily Medicine male 2002 80536 closed/unable to service debtFamily Medicine male 2003 80524 sudden death, age 52Internal Medicine male 2002 80524 sold/less profitableInternal Medicine male 2004 80524 sold/less profitableFamily Medicine male 2004 80524 sold/less profitableInternal Medicine male 2004 80524 sold/less profitableFamily Medicine female 2006 80524 closed/unable to service debtFamily Medicine female 2006 80524 closed/unable to service debtFamily Medicine male 2006 80550 closed/unable to service debtFamily Medicine female 2007 80526 closed/unable to service debtInternal Medicine male 2007 80524 sold/less profitableFamily Medicine female 2007 80550 closed/unable to service debtFamily Medicine male 2007 80537 closed/?Internal Medicine male 2007 80537 closed/moved to BTMGFamily Medicine female 2003 80526 I can not disclose under contractGynecology male 2005 80524 closed/divorce?OB/Gyn female 2003 80528 ?OB/Gyn female 2003 80528 ?Family Medicine female 2002 80524 ?OB/Gyn female 2002 80524 ?Family Medicine male 2008 80528 unable to service debtFamily Medicine male 2008 80521 uncertainFamily Medicine male 2008 80521 offered job in Sports MedicineFamily Medicine male 2008 80524 sold/less profitableInternal Medicine female 2008 80524Internal Medicine male 2008 80524 sold/less profitableFamily Medicine male 2008 80549 closed by CRMC, non profitable
Hospital Movement
• IN the past 4 years: The number of EM physicians double, and ED utilization increases by 50%.
• IN the past 2 years: 250 physicians become employees of the local hospital owned medical group (600 total physicians in the county)
Our Product in 2002…
• Test results are slow• Labor costs high with much non-revenue generating activity /
waste• No open appointments• No clinical data management• Barely any financial data management• High variability in patient experiences from day to day• Documentation illegible• Unable to compete with retail clinics, urgent care, emergency
departments, etc.
Wanting to get out of last century…
“The Restaurant with Bad Food”
Made friends with the banker, accountant, attorney and local business leaders
• We decided it would take money to make money and the process starts with investing
• We pledged that we would make Miramont safer, more efficient, and up to date
• Ensure our own profitability at all times in order that we could be there for our patients for many years to come
• Eliminate as much as possible non-revenue generating activity• Find ways to provide needed services in our house, in the free
market health care system that we are given• Find a better EHR (transition out of a free product we acquired
in 2005)• Attain NCQA recognition for a Patient Centered Medical Home
$1.4 million in new building in 2005
Every Year We Bring New Products and Services
• 2002 Female Provider, DEXA scanner• 2003 Level 2 Laboratory, IV therapy• 2004 Visiting Surgeon, 8-5 hours M-F• 2005 New Building, X-ray, bilingual services• 2006 Physical Therapy, Psychotherapy, After Hours• 2007 INS, Coumadin clinic, Nerve Conduction studies, Saturday hours,
Nurse Educator• 2008 Female Physician, Colposcopy, Pain Management Specialist,
Group visits, The Dispensary, Psychologist
Every Year We Bring New Products and Services
• 2009 Patient Centered Medical Home, New Website, patient portal, online registration, online scheduling requests, online bill payment, Miramont Value Plan (MVP), Allergy Testing and AIT, Second location and Third Locations, Laser Aesthetic
Medicine• 2010 Botox, digital Mammography, Audiology, Pediatrician, CEO level
administrator, email blast marketing to patient base, automated collections calls
• 2011DME sales, drive through pharmacy, fluoride dental treatments for children
• 2012 4th location in Parker Colorado, self check in kiosks, Phreesia tablets, Medtronics Insulin pumps, iPro
• 2013 5th location Loveland, 6th location Fairplay, 7th location Glendale
THE PROCESS OF GAINING NCQA RECOGNITION or
ACHIEVING MEANINGFUL USE IS A WORKFLOW
REDESIGN PROCESS IN ITSELF
Quality Focused – Practice Tranformation
• Basic Tenants in the PCMH/Specialist Practice Transformation:– Physician Leaders who are willing to
lead a team.– Every person on the team must be empowered
to contribute to process improvement and workflow redesign
Process as a Root Cause7 Causes of Waste or MUDA
How to Make a Physician Owned Lab (POL) Work in Your Office: Evaluating the
Costs and BenefitsJohn L Bender, M.D., FAAFP & Amanda J. Cline, RMA
Old Model• Physician orders test• MA fills out requisition• Patient given directions to local lab• Patient drives to lab, has test drawn• Outside lab runs test• Test is reported back to physician next business
day• MA pulls chart to go with test• Physician reviews test, signs it off, and tries to
remember what he/she was looking for…
Old Model, continued…• MA calls and leaves message on answering
machine telling patient that results are in but unfortunately due to HIPAA cannot leave results on machine and patient will now have to call back
• Patient’s spouse hears message, assumes the worst, and calls back three times with an urgent message asking for a return call from physician
• MA finally makes contact with patient, new medication is ordered, another follow-up visit is scheduled with repeat blood work ordered
• Receptionist refiles chart.• TOTAL TIME: 20 + minutes
New Model• Physician orders test• MA draws patient• Test is run in house• Result is reported in room to physician and
patient• Decision is made for new med, result is signed
off• Patient schedules follow up at check-out• Chart is filed• TOTAL TIME: 10 minutes
We finally know how many diabetics we have
A1C documentation improved over time
Managing population metrics for
chronic disease is
realistic with an EHR
Leveraging New IT
Leveraging New IT
Build the Medical Neighborhood
A Call for Courage
“Sometimes the opposite of Cautious is not Careless… Sometimes the opposite of Cautious is Courage”
- John L Bender, M.D., FAAFP
Overview of PCMH – an Xtreme Makeover
From the Patient and Physician PerspectivePresented by John L Bender, M.D., FAAFPJanuary 9th, 2014Colorado PCPCC, Denver