How independent primary care physicians can improve patient satisfaction in 2018

Healthcare costs are one of the main concerns of patients in 2018. Health insurance premium costs are rising as are the costs incurred by patients for procedures and prescriptions outside of that covered by insurance. It would make sense, then, that patient satisfaction in the primary care physician’s office could, in large part, be improved with billing procedures that are more patient-friendly. Waiting times are also of concern to patients, so scheduling improvements are another effective way to improve patient satisfaction in 2018. A survey conducted by HIMSS Analytics, the Patient Payment Check-Up found that “48 percent of patients find providers' bill paying options inconvenient. However, survey respondents were also clear on what they do like: 52 percent of patients prefer electronic billing” rather than receiving paper bills in the mail. Ensuring that patients clearly understand what is expected of them, including how much they will owe and when their payment is due, will also increase the patient’s level of satisfaction with the overall billing process. The survey found that providing upfront estimates will “help patients know how much they owe, enabling them to make informed care decisions and initiate a conversation with the practice about how to pay.” A separate survey conducted nationally of 5,031 patients found that these patients’ main concerns were healthcare costs and wait times. In addition to billing issues, the primary care physician’s patients are also concerned about the time they have to wait to schedule an appointment and the amount of time they spend in the physician’s office waiting to see a medical professional. Communication with patients throughout the process, from appointment scheduling to the patient visit to the billing process, can significantly improve patient satisfaction for the primary care physician in 2018. The use of technology, including the tools found in electronic health records, is preferred by most patients who no longer want to deal with paper bills or appointment forms.

Parker Nieves
January 17, 2018

Read

How physicians define value-based care versus patients

What do independent physicians and their patients think of the trend toward value-based care? How do they view the meaning of value in healthcare? The answers are different, depending on who is answering those questions. A survey commissioned by University of Utah Health and conducted by Leavitt Partners found that patients and physicians view the value of their healthcare from very different perspectives. In the results of the survey, conducted nationally and involving 5,031 patients, 687 physicians, and 538 employers, “several key misalignments, as well as surprising points of convergence, were revealed.” Essentially, while patients were concerned with cost and availability, physicians focused on patient relationships and outcomes. Cost was the clear priority for patients when asked about their top value statement. Patients were also concerned about the time they had to wait to schedule an appointment and the time they spent waiting to be seen when at the physician’s office. Only 32% of the patients participating in the survey chose “My health improves” as their top priority. This result is somewhat counterintuitive for physicians who are trained to focus on their patients’ health as their top priority. In fact, the majority of physicians participating in the survey held themselves accountable for their patients’ health outcomes, seeing quality of care as a significant indicator in value-based care. When asked who is responsible for value-based care, physicians “overwhelmingly hold themselves responsible for ensuring that a patient’s health improves while patients equally hold themselves and physicians accountable.” Coordinated care thus becomes even more important as physicians find they need to “align themselves more closely to patients’ vision of value, and consider all stakeholders—systems, payers, employers, patients and providers—as jointly responsible for ensuring high value care.” As the emphasis on value-based care continues into 2018 and beyond, often impacting independent physicians’ financial incentives, the study concludes that “providers will have to better address access, convenience service and cost when determining value.”

Roy Steiner
January 16, 2018

Read

5 ways primary care plays a role in patient care and the community

The primary care physician plays a vital role in a patient’s healthcare outcomes. Primary care is the “point of entry,” the first line of defense against disease, and the coordination point for expanded healthcare service for the patient. Primary care also impacts the community as a whole, providing a focused point of assistance for the patient’s extended support network and managing population health overall. There are five main ways that primary care plays a role in patient care and in the community: Prevention The primary care physician ensures that patients receive the appropriate immunizations and screenings that help prevent serious conditions such as influenza. Primary care also plays a role in helping patients learn more about the effects of adverse lifestyle issues, such as smoking and obesity, working with them on cessation and weight reduction plans that prevent further, more serious issues from arising. Early detection Research has shown that “patients admitted to hospitals with complications related to a manageable health condition, such as hypertension, were four times more likely to lack access to a primary health care provider.” The primary care physician is able to monitor a patient’s signs and symptoms and manage potentially adverse health conditions to help the patient reduce the likelihood of developing a more serious condition. Coordination of care When a patient’s condition needs further treatment, the primary care physician is most effective in coordinating with specialty providers and healthcare facilities. Using technology tools such as electronic health records (EHRs), the provider is able to seamlessly and efficiently coordinate that care. Healthier communities through increased access The community as a whole benefits when its members are healthier. Studies have shown that populations that have access to primary care tend to have healthier outcomes. Primary care access is “particularly important for isolated or deprived population groups that may not have the means to access these services otherwise.” Continuity of care The primary care physician who becomes the main point of contact throughout a patient’s medical care is able to monitor any change in that patient’s situation and quickly act upon it, with diagnostic tests or preventative services. The patient benefits tremendously from having a medical home in the primary care physician’s office.

Greg Miller
January 12, 2018

Read

The role primary care physicians play in ensuring ACO success

Accountable care organizations (ACOs) are formed by independent physicians who share a common goal of giving “coordinated high quality care to their Medicare patients.” The Centers for Medicare & Medicaid Services (CMS) further explains that “When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.” What factors impact the success of the ACO? How do those independent physicians play a role? A study published in Health Affairs indicates that physicians “are the crux of the ACO itself,” according to Dr. John Hsu, lead author of the study. The key to an ACO’s success appears to lie in the physician’s attitude toward the organization, its patients, and its payer. Dr. Hsu further explained that some of the ACOs in his study were “cherry picking” low-risk patients and that there were actually modest financial incentives even among the successful organizations. According to Dr. Hsu, “’the key point is that the physician played a central role,’ because a physician's participation in an ACO can heavily influence its financial and quality outcomes.” A more recent report in Health Payer Intelligence, however, indicated that ACOs have “gained traction over the last year as payers and providers begin to share the same viewpoints on the benefits of value-based care.” Provider attitudes toward the ACO and its success are becoming more positive and the trend is leaning toward more ACO agreements among independent physicians. The main challenge seems to getting providers and payers to agree on definitions of value and of quality measurement. With the recent shift toward cooperation and coordination, however, Jeff Hulburt, CEO of Beth Israel Deaconess Care Organization (BIDCO), has indicated that “2018 should be a year in which the ACO environment continues to mature, even if progress is likely to happen slowly” in regard to policy debates at the federal level.

Roy Steiner
January 9, 2018

Read

Learn more about the history of primary care

The family physician has existed in various forms in the US for centuries. In the earliest days, the doctor may not have had formal medical training but did treat everything and everyone, usually in their own homes. Today, family medicine is considered to be a category of primary care, a term that was originally coined in the UK. World War I created a heavy healthcare and financial burden on Europe. In 1920, Sir Bertrand Dawson prepared the Dawson Report for Britain’s Council on Medical and Administrative Services, in which he “recommended the creation of a general medical service and set forth the notion of primary care.” The term “primary” was used to distinguish the healthcare service from secondary facilities such as health centers and hospitals. In the US, the idea of primary care did not take hold until the 1960s. Two major reports published during this period helped to define both the need for and the definition of primary care. One report was produced by the American Medical Association’s Ad Hoc Committee on Education for Family Practice. The report was known as the Millis Report as the committee was chaired by John Millis, then the president of Case Western Reserve University. The Millis Report emphasized that every individual needed a primary physician. In 1966, William Willard, then vice president and dean of the University of Kentucky Medical Center, led the effort to produce the Council Report on Education for Family Practice. This report “focused on family medicine as a needed reform of general practice to balance an overemphasis on medical specialization.” Today, primary care includes both family practices and internal medicine. Although primary care takes many forms now, it still focuses on being the patient’s first line of healthcare services. Many primary care physicians also collaborate with those secondary healthcare facilities as well as with specialty providers and laboratories to provide quality care for their patients.

Parker Nieves
January 8, 2018

Read

State programs that aim to shift focus to primary care

Several states throughout the US are prioritizing their focus on primary care services, through legislation, financial investments, or support of corporate efforts. Glen Stream, MD, FAAFP, MBI, a family physician practicing in La Quinta, California, past president of the American Academy of Family Physicians, and current president and board chair of Family Medicine for America’s Health, writes in Medical Economics that the shift of focus has occurred in a number of states across the country: Oregon: Dr. Stream states that Oregon is quite possibly the “country’s current champion innovator” in regard to investing in primary care. With initiatives in place that “recognize the central role primary care plays in achieving the triple aim of improving patient health and quality of care while lowering costs,” Oregon has seen cost savings in return for increased spending on primary care. Michigan: A patient-centered medical home (PCMH) led by Blue Cross Blue Shield has produced “a transformation of care that has resulted in a 15% decrease in adult visits to emergency departments and a 21% decrease in ambulatory care-sensitive inpatient stays.” California: Covered California requires all enrollees to be matched to a “primary care physician, nurse practitioner or another primary care clinician as a patient advocate and first point of contact.” The program now includes approximately 2 million people, with the potential to reach another 21 million. Rhode Island: In a state where Medicaid accounts for about a third of the total budget, there was “a significant drop in total medical spending after its health insurance commissioner required all commercial plans to increase spending on primary care by 1% of total spending per year over a five-year period.” When spending on primary care increased, Medicaid costs decreased. Additionally, a pilot program involving home visits for financially disadvantaged patients resulted in “decrease of more than 60% in both hospitalization rates and emergency department visits over a six-month period in 2016.” Dr. Stream emphasized that increased focus on primary care is literally a life-and-death issue, adding that more physicians are needed in primary care practice, to improve the quality of care, to reduce healthcare costs, and to save lives.

Greg Miller
December 11, 2017

Read

Adding ancillary services at independent primary care practices

As a primary care physician, you are focused on making sure your patients have what they need to lead healthy lives. You provide basic services, coordinate with specialty providers, and work with labs and pharmacies to be sure your patients receive the appropriate care. You may also be considering expanding to include ancillary services at your independent primary care practice. The first step to take when considering whether adding ancillary services is right for your practice is to determine the financial ramifications. Those services will probably bring in additional revenue, but they will also carry a cost with them. Rather than purchasing expensive equipment to provide ancillary services, for example, it might make more sense to lease the equipment or to have a contract service come to the practice on a regular basis. Determining whether the ancillary service will actually be useful to and used by patients is another important step. Bringing lab services in-house may be enticing to patients who feel more comfortable having their laboratory tests done at the practice itself rather than having to go to another facility. Doug Graham, a practice consultant at DoctorsManagement in Knoxville, Tenn., advises that independent primary care "practices need to determine whether or not they have the requisite demographic to truly benefit from the service.” Potential ancillary services to provide at an independent primary care practice include those laboratory tests, mobile mammography services, ultrasound, allergy testing, imaging, transitional care, and chronic care, among others. The added services must make sense to the practice and to the patient base. Graham adds that the independent primary care physician should look carefully at the potential reimbursement for ancillary services, particularly where billing codes could become an issue. He cautions that "even though Medicare says they will pay for [a service], a doctor should always check with their local coverage determination. Some of these ancillaries will have a global CPT charge, a professional fee, and a technical fee.”

Nick Dealtry
December 8, 2017

Read

Value-based care on a state level

The shift to value-based care from the fee-for-service model has focused on the Centers for Medicare & Medicaid Services (CMS), on the federal level. However, many states have value-based programs for medical providers as well. A recent study found that a number of states have “created value-based programs to work with healthcare stakeholders to redesign the healthcare system.” These state initiatives are relatively recent, according to the study: 6 states launched valued-based payment programs four or more years ago 23 states started their programs two or more years ago 10 states are still in the early stages of rollout In addition, the study found that: 17 states adopted or are considering creating accountable care organizations (ACOs) or similar entities to manage cost and deliver better care. 12 states adopted or are considering episodes of care programs. 23 states created value-based payment targets or mandates, which payers and provider must achieve. Value-based care focuses on the quality of the healthcare provided to patients, rather than the number of patient visits. Independent physicians are reimbursed based on quality measures established by CMS. They also face the challenge and the burden of a significant number of regulations and reporting requirements as a result of the move to value-based reimbursement. Dr. Jason Spangler, executive director of value, quality, and medical policy at Amgen, addressed the News & World Report's Healthcare of Tomorrow conference recently, indicating that value-based care should shift to the patient to some extent.  ““We should pay and incentivize patients toward high-value care and disincentivize them against low-value care.” CMS has recognized the burden that independent physicians face and has taken steps to alleviate some of the paperwork involved. Many in the healthcare field believe that additional steps must be taken, beyond the federal initiatives. Partnerships between healthcare payers and providers could involve ACOs similar to those adopted or considered by 17 states as well as additional patient-centered medical homes, to improve the quality of healthcare and to further emphasize and reward value-based care.

Tyler Comstock
December 6, 2017

Read

The relationship between value based care and quality measurement

The move toward value-based care for the independent physician requires data and time. A significant part of the challenge in value-based care is having the ability to measure quality quantitatively. The primary care physician must have a baseline from which to start and then must continue to have reliable data from which to measure that quality. All of that takes time, as does value-based care itself. Few medical interventions produce immediate results. The Centers for Medicare & Medicaid Services (CMS) defines value-based care programs in terms of how they impact the physician caring for a Medicare patient: “Value-based programs reward health care providers with incentive payments for the quality of care they give to people with Medicare.” In addition, value-based programs support the “three-part aim” of CMS in terms of how that care impacts the patients themselves: Better care for individuals Better health for populations Lower cost Quality measurement also needs to reflect care that needs improvement. As Jason Goldwater, Senior Director at National Quality Forum, as quoted in EHR Intelligence, explains, “Not only should quality measurement give you information, but it should also should show you the pathway for what you need to do to make corrections if necessary or to continue to be consistent in delivering quality and efficient care that will continually meet those measures.” Interoperability plays a key role in quality measurement as well, as it is necessary for the primary care physician to have reliable data available. Electronic health record (EHR) systems must have the ability to talk to each other, to enable the primary care provider to coordinate a patient’s care and to enable each healthcare provider caring for that patient to view the patient’s medical information. Data culled from those interactions then becomes part of the quality measurement process.

Tyler Comstock
November 28, 2017

Read

What is holistic primary care?

Understanding a patient’s complete medical profile is crucial to being able to treat that patient’s medical conditions effectively. For many patients, there may be other factors involved in their medical diagnosis, including their lifestyle, their family situation, or even their economic status. Outside issues such as stress can significantly impact a patient’s health status. Understanding these additional influences is a part of what makes up holistic primary care. An article in the Indian Journal of Palliative Care, “Effective Factors in Providing Holistic Care: A Qualitative Study,” describes holistic care as “a behavior that recognizes a person as a whole and acknowledges the interdependence among one's biological, social, psychological, and spiritual aspects.” Further, the article states that “holistic care includes a wide range of approaches, including medication, education, communication, self-help, and complementary treatment.” Holistic primary care takes into consideration the patient’s complete profile and not just a medical diagnosis. The primary care physician must develop a relationship with the patient that includes asking questions and truly listening to the answers, to fully develop that comprehensive profile. The patient is also a key player in holistic primary care. Patients who are given access to their electronic medical records (EHRs), for example, have the information they need to become engaged in their own healthcare plan. When they are encouraged to communicate with their primary care physician, to ask questions or to get clarification on diagnoses and instructions, they feel more empowered to be an active part of their own care. Primary care physicians who take the time to understand the patient’s social, psychological, and spiritual life in addition to the biological information discovered during the visit are able to more effectively provide holistic primary care for that patient. The provider can take all of these factors into consideration and work with the patient on a healthcare plan that works based on that particular patient’s holistic profile.

Nick Dealtry
November 27, 2017

Read

The important role primary care physicians play in the patient-centered medical home

Managing a patient’s care, to ensure the patient remains healthy and to catch potentially serious diagnoses early, is one of the main focuses of a primary care physicians. Most patients look to the primary care physician to coordinate their care with specialty providers, labs, and healthcare facilities. The patient-centered medical home (PCMH) enables this coordination to happen, continuously throughout a patient’s life. The primary care physician’s role is vital to the patient in a PCMH, both from the perspective of the patient’s overall health and because of the current trend toward value-based care. The number of patient visits is no longer as important as the outcome of those visits, for the patient and for the physician. In a PCMH, the provider has the ability to monitor a patient’s health status long-term, across multiple visits throughout various stages of the patient’s life. The primary care physician is able to engage the patient, to ask pointed questions, and to observe changes or signs that may need further exploration by a specialty provider or diagnostic lab. The independent physician working with a patient who has been diagnosed with a chronic condition has a more involved role in coordinating care for that patient. Patients with chronic or complex conditions generally see multiple providers and require focused coordination throughout their care. A PCMH home for that patient enables the primary care provider to more effectively manage the patient’s coordinated care. From the patient’s perspective, a 2015 survey conducted by Accenture showed that “a majority of patients want their care managed at one central point.” Almost 87% of those participating in the survey said that “that their primary care providers should be the epicenter of all of this care coordination.” Engaging and communicating with patients throughout their diagnosis and care plan can also encourage patients to become more involved in their own healthcare, which has been shown to be significant in their overall outcomes.

Nick Dealtry
November 20, 2017

Read

What is risk assessment in primary care?

Reviewing a patient’s medical data and asking pointed questions during wellness visits can help the primary care physician conduct a meaningful risk assessment for that patient. As the Agency for Healthcare Research and Quality (AHRQ) notes, “Obtaining periodic health assessments on patients provides an opportunity for primary care teams to get a snapshot on the health status and the health risks of empanelled patients.” Primary care physician who manage their patient’s medical information using electronic health records (EHRs) have the ability to review notes before the visit and then input relevant data during the visit that can impact the risk assessment for that particular patient. Identified risks could include smoking, drinking, adverse family medical history, or socioeconomic factors, as well as “hearing loss, increased fall risk, depression, or previously unidentified chronic pain.” The Centers for Disease Control (CDC) has published A Framework for Patient-Centered Health Risk Assessments, focused on “Providing Health Promotion and Disease Prevention Services to Medicare Beneficiaries.” Although primarily discussing patient-centered health risk assessments (HRAs) and their impact on Medicare patients, the framework provides insight into risk assessment at the primary care level. The CDC points out that “Chronic illnesses account for an estimated 83% of total U.S. health spending and virtually all (99%) of Medicare’s expenditures are for beneficiaries with at least one chronic condition.” Risk assessments are particularly important for this population. One of the CDC’s goals in developing recommendations as part of their framework include improving “health outcomes by identifying patients’ modifiable health risks and providing follow-up behavior change interventions that are implemented over time.” Recommendations for the patient-centered risk assessments in the primary care practice include: Balance comprehensiveness of assessment with provider and patient burden Build upon high priority questions Use person-centered and culturally appropriate processes Incorporate information into secure electronic health records Conduct research to quantify long term outcomes Elation Health’s Risk Assessment feature leverages patient chart data and an industry standardized measure to empower providers with a snapshot of patient’s health risk at the point of care.

Kimmy Hu
November 10, 2017

Read

Why PCPs should care about value-based care

The shift from fee-for-service to value-based care is a topic of concern for many independent primary care physicians (PCPs). Of course, PCPs and value-based care usually always go hand-in-hand, as PCPs are focused on providing the highest quality care to their patients. However, with changing requirements and reimbursement guidelines there are many reasons that PCPs should care about the transition to value-based care in their field. The shift to value-based care moves the independent physician away from tracking the number of patient visits and toward a better understanding of the quality of each visit as well as patient outcomes. As the American Academy of Family Physicians (AAFP) notes, the focus on value-based care will “enable family physicians to finally be able to offer patients the kind of care that drew them to medicine in the first place – personal, proactive care that provides true value for patients without wasting resources.” Some of the administrative burden in reporting may be a challenge for smaller practices, but there is primary care software available to help the PCP manage patient data more efficiently. Elation Health’s electronic health record (EHR) system for Primary Care Physicians, for example, assists the independent physician in driving outstanding patient outcomes while supporting the crucial patient-physician relationship. AAFP reports that smaller practices may actually have an advantage when it comes to providing – and reporting – value-based care. According to the AAFP, Smaller practices have a lower average cost per patient, cause fewer preventable hospital admissions, and have lower readmission rates when compared with larger practices.” Elation Health is also committed to the newly developing focus on PCPs and value-based care. We designed our EHR System for Primary Care Physicians to enable independent physicians to spend more time with patients and less time on paperwork. Our mission has always been and will continue to be a commitment to strengthening the relationship between patients and physicians, and enabling phenomenal care for everyone.

Greg Miller
November 6, 2017

Read

Collaborative primary care can help with opioid addiction

The opioid crisis in America is being officially declared a public health emergency by President Trump. A New York Times study found that deaths from drug overdose exceeded 59,000 in 2016 and that drug overdoses are now the leading cause of death in Americans under the age of 50. The Times says that “all evidence suggests the problem has continued to worsen in 2017.” There are many possible solutions to the opioid crisis, among which is the ability of primary care physicians to collaborate with other providers to help patients with opioid addiction. There have been a number of studies pointing to the need for collaboration for effective opioid addiction treatment. Research is also being conducted on the addiction and treatment methods. A group of researchers at the University of Michigan believe that “many of the two million Americans addicted to opioids can receive treatment and assistance in getting off prescription painkillers or heroin from a primary care team.” The researchers state that a collaborative team-based approach, along with the use of medication assisted therapy (MAT), can have a significant impact on the rate of opioid addiction in the US. Primary care physicians must be trained and certified in the administration of buprenorphine, a medication that has been proven to help those addicted to opioids. Although primary care physicians are understandably overwhelmed already, taking those few extra steps to collaborate with other physicians may prove to make the difference in helping patients with opioid addiction. In fact, research has found that “patients had the highest chance of successful opioid addiction treatment when their primary care physician worked with a team of non-physicians to deliver MAT.” The University of Michigan researchers believe that primary care physicians can make a huge difference in the opioid crisis, working in a “collaborative team-based intervention [that] typically includes physicians, nurses, medical assistants, social workers, and pharmacists.”

Tyler Comstock
November 2, 2017

Read

Clinical First EHR features: Dynamic Problem List

Maintaining a current and accurate patient problem list is not only an effective way to track a patient’s medical progress, it is also now a core measure in the Meaningful Use specifications established by the Centers for Medicare & Medicaid Services (CMS). Traditionally, notes regarding patient problems have been kept on paper in the patient’s files. The physician would review those notes prior to a patient visit and add follow-up notes after each visit. With the advent of electronic health records (EHRs), however, these notes can now be entered and annotated quickly and easily. An overview of the patient’s medical history is now available to the physician and the assisting clinical staff, making everyone’s time spent with the patient more efficient and effective. Elation’s Clinical First EHR features a Dynamic Problem List designed for independent physicians who want to spend more time providing quality healthcare to their patients and less time on paperwork. The Dynamic Problem List feature enables providers to import a problem list and associated lab values into visit notes with just one click. We have integrated a smart-mapping algorithm that will organize the Subjective section to make the process even more efficient. Action items can be prioritized with a dynamic sort, to enable the provider and clinical staff to view and act on the most important issues first. Patients want their physician’s attention during a visit and physicians want to be able to provide quality care during the time they have to spend with the patient. The Dynamic Problem List includes a Smart Visit Note feature that will automatically record the provider’s actions during the patient visit, so the physician does not have to spend excessive amounts of time writing visit notes. Charting can be completed with a variety of notation templates, including free text and dictation support. Additionally, report views and lab orders that occur during a patient visit are automatically logged in the Objective section of the visit note. At Elation, we focus on helping independent physicians become more efficient and more effective in providing quality healthcare to their patients. Our Dynamic Problem List is another invaluable feature of our Clinical First EHR, designed to accomplish those goals.

Greg Miller
November 1, 2017

Read

Hundreds of healthcare organizations show support for primary care transformation

Over 200 organizations “representing diverse healthcare stakeholders” have indicated their support for the Patient-Centered Primary Care Collaborative (PCPCC)’s comprehensive set of Shared Principles of Primary Care. What does this mean for the transformation of primary care? To date, 240 names have been added to the list of organizations that have signed onto the Shared Principles. According to the PCPCC, these principles “chart a new chapter for advanced primary care that successfully engages patients in decision-making, relies on team-based care, incorporates population health, and commits to stewardship of scarce resources.” The principles were developed through a collaborative effort “with leadership from the PCPCC and Family Medicine for American’s Health (FMAHealth), as well as input from organizations that span all aspects of health care, including consumers and payers.” The 240 organizations that have signed on to show support for this transformation of primary care include “physician and nursing organizations, consumers, employers, health plans, and hospitals.” PCPCC describes the principles as an “aspirational vision for the future of primary care.” With the current shift toward value-based care, in particular, the principles are designed to encourage patient engagement, coordination with other providers, and a team-based approach to patient healthcare, with a goal of improving primary care delivery and outcomes. The PCPCC shared principles urge primary care to be: Person & Family Centered Continuous Comprehensive & Equitable Team Based & Collaborative Coordinated & Integrated Accessible High Value Glen Stream, President and Board Chair of FMAHealth, says, in voicing support for the organization’s coordination with PCPCC on these efforts, that “the Shared Principles is a powerful framework to move the United States toward a vibrant future of person-centered, team-based, community-aligned primary care.” Organizations can sign on to support the Shared Principles, joining 240 current signers, online.

Parker Nieves
October 30, 2017

Read

Treating patients seeking primary care after emergency room visits

When a patient visits an emergency room (ER) for treatment of an injury or illness, follow up care is often recommended. Unfortunately, many patients who use the ER for such visits do so because they do not have an established primary care physician. A recent study found that patients who do try to follow up their ER visit with a primary care physician may not be able to get a timely appointment. A research study, published in the Annals of Emergency Medicine and presented at the American College of Emergency Physicians Scientific Assembly Research Forum, October 2016, Las Vegas, NV, focused on “Insurance Status and Access to Urgent Primary Care Follow-up After an Emergency Department Visit.” The study employed 2 African American men who posed as recent emergency room patients seeking a follow up visit with a primary care physician. The research participants made a total of 604 calls that covered “all possible scenarios based on 3 insurance types (Medicaid, state exchange, and commercial) and 2 conditions (hypertension and back pain).” Overall, they were able to secure a follow up appointment within 7 days only 30.7% of the time. The 7-day appointment rate for those presenting themselves as being diagnosed with hypertension was 33.7% and for those presenting themselves with lower back pain was 27.6%. When the participants presented themselves as Medicaid recipients, their 7-day appointment rate was lowered to 25.5%. 94 of the calls made as Medicaid recipients were declined completely, with the primary care physician’s office citing the fact that they did not accept Medicaid or that their number of Medicaid patients for the month had reach its limits. Overall, the study “found access to 7-day follow-up appointments to be difficult across all insurance statuses and clinical conditions compared with previous studies conducted in other cities.” Researchers recommended, based on the results of this study as well as others recently conducted, that “EDs should actively assess the availability of and access to primary care follow-up in the local community and, if needed, consider alternative approaches to discharge care transitions, such as providing 30-day prescriptions of antihypertensives or scheduled follow-up in the ED.”

Greg Miller
October 26, 2017

Read

States focus on primary care models to increase access

Balancing the needs of patients seeking affordable healthcare with the market demands of insurers is challenging. Add to that the continuing debate over the Affordable Care Act (ACA) and the emphasis on value-based care and the situation becomes even more complicated. At the recent Patient-Centered Primary Care Collaborative Fall Conference, presenters discussed the strategies used “in states that make primary care the foundation for increasing access to care.” One of the most significant challenges is that the uninsured regularly use the emergency room as their regular healthcare facility, whether seeing a physician there for a major injury or for routine care that should be part of a primary care physician visit. This practice results in increased costs and inconsistent care. As Peter Lee, J.D., executive director of Covered California, stated at the conference, "We have to change the culture by moving their normal point of care." Lee also discussed ways in which California is able to maintain “a balance between affordable plans for consumers and a market that insurers want to be in.” Covered California “requires participating plans to address four priorities: promotion of primary care, health disparities, coordinated care and a move away from strict fee-for-service payment. Another example of a state increasing access to primary care is the patient-centered medical home (PCMH) model implemented by Oregon in 2009, and to which it moved 75 percent of its residents. There are now “630 PCMH practices statewide, and 80 percent of residents obtain care in one of these practices.” Evan Saulino, M.D., Ph.D., a family physician who serves as clinical adviser for Oregon's Patient-Centered Primary Care Home program, stated at the conference that Oregon’s “medical home model saved $240 million in health costs in its first three years.” Dr. Saulino also noted that "there are some things that both parties can agree upon across the political spectrum, and primary care transformation is one of them."

Roy Steiner
October 25, 2017

Read

95% of primary care patients satisfied with their physicians

Out of 1,747 participants in a study conducted in June 2017, 95% said they were either “very satisfied” or “somewhat satisfied” with their primary doctor. The study was conducted by the Physicians Foundation, who contracted a private consulting firm to provide online questions to healthcare consumers “between the ages of 27 and 75 and have seen the same doctor at least twice in the past 12 months.” In the survey, participants were asked a wide range of questions about their primary care physician, or the physician that they considered to be their primary care doctor. Questions were focused on four major areas: “the physician-patient relationship, the cost of healthcare, social determinants and lifestyle issues.” The first question asked about the survey participants’ satisfaction with their primary doctor. That was followed by the second question, which asked if they had ever considered changing their primary doctor. 80% responded “not that much” or “not at all.” Those who said they were considering a change in their primary care doctor gave a variety of reasons including “the doctor does not do enough, because they do not listen to them, or does not provide enough personal service.” In a later question, 77% of the participants said they want their doctors to listen to them more. Additional reasons given for considering a change in doctors included “location and/or distance … slow service or the wait time is too long … [and] it is hard to get appointments.” Others wanted a second opinion and felt they have found a better doctor. In this same study, 85% of the participants indicated that their physician’s use of electronic health records (EHRs) helped patient care either “a great deal” or “somewhat.” Likewise, 85% of the respondents said that “Technological advances in healthcare will greatly improve the quality of care patients receive.”

Roy Steiner
October 24, 2017

Read

What is the medical home model?

Patients with complex conditions usually see more than one physician and undergo multiple lab tests and procedures. When those patients have a medical home, their care can be better coordinated by their primary care physician. The medical home model provides a central point of care, from which decisions are made and healthcare is provided that is truly coordinated and of the highest quality. Research has shown that patients with complex conditions, in particular, realize reduced costs and improved results when their care is provided by the medical home model. Whether patients have complex or simple conditions, knowing that their care is provided and coordinated by a single primary care physician can alleviate concern about miscommunication and duplication. The medical home model, as defined by the Patient-Centered Primary Care Collaborative (PCPCC), is “best described as a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety.” In the medical home model, the patient-provider relationship is of utmost importance, as the primary care provider works with the patient as well as with the patient’s family, to determine the most appropriate and acceptable plan of care. The PCPCC describes the medical home model as: Patient-centered: Decisions regarding care take into consideration the needs and desires of the patients and their family, in addition to the professional knowledge and expertise of the primary care physicians. Patients are encouraged to engage in their own healthcare by taking part in the decisions. Comprehensive: In the medical home model, care is provided for all healthcare needs, from prevention and wellness to care for acute and chronic conditions. Coordinated: The primary care physician collaborates with specialty providers, labs, healthcare facilities, and other providers to ensure the patient’s care is properly coordinated. Accessible: Engaging patients in their own healthcare decisions necessitates enabling their access to their medical information. Electronic health records (EHRs) play a significant role in accessibility for patients, particularly when a communication piece is available to them. Committed to quality and safety: Informed decisions, based on patient input and coordination with multiple providers enables the primary care physician to provide high quality, safe healthcare for improved outcomes.

Parker Nieves
October 20, 2017

Read

Study shows the impact of care managers at primary care practices

Chronic disease requires a high level of coordination by the primary care physician, working with multiple specialty providers, labs, and healthcare facilities to ensure the patient’s care is provided efficiently and effectively, without duplication or error. To help the process move forward smoothly and to help the patient gain a clearer understanding of the healthcare plan provided by these multiple providers, the primary care physician may involve the services of a care manager. A research study recently published in Journal of Primary Care & Community Health, found that care managers had a significant impact on the diabetic and obese patients of primary care practices. According to the research report, about half of Americans have at least one chronic illness. It has also been found that patients with chronic conditions improve their outcomes when they “follow recommended treatment regimens, obtain relevant tests for monitoring of their disease(s), perform self-management activities, and follow a healthy lifestyle.” Care managers working at primary care practices can help patients with these tasks. The Journal report states that care management is typically “provided by nurses, social workers, dietitians, pharmacists, or others” and “can be delivered via telephone or other means, although face-to-face in-practice interaction is almost often included.” Care managers play a role in patient’s chronic disease management, care coordination, and self-management support.” The research showed that the diabetic patients generally improved their A1c control and the obese patients were able to lose weight, when they worked with a primary care practice’s care manager. Among the patients at the ten primary care practice studied, there was a “a 12% relative increase in the proportion of patients meeting the clinical target of A1c <7% (95% CI, 3%-20%), and 26% of obese nondiabetic patients in chronic care management practices lost 5% or more of their body weight as compared with 10% of comparison patients.”

Tyler Comstock
October 16, 2017

Read

Strategies for patient-centered communication and care

The patient-provider relationship is crucial to quality healthcare. That relationship is usually developed through quality communication, during and after the visit. Patients need to know they can discuss all of their healthcare issues with their provider. Occasionally, they may even feel the need to discuss life management and sensitive issues. The independent physician needs to initiate the conversation as well, to encourage that communication with their patients. A recent Health Reform Monitoring Survey (HRMS), published by the Urban Institute Health Policy Center, found that patients are generally comfortable with the level and frequency of communication they have with their provider. However, the survey also found that it is usually the patient and not the provider who initiates that communication. Physicians who want to improve their communication efforts can easily do so with some simple strategies. Patients want physicians to ask them about issues they would consider to be sensitive. As HRMS points out, “Patient-centered care models depend upon patients and providers communicating about sensitive issues, but such conversations may not occur as often as they should.” Physicians who take the initiative to ask about sensitive issues will improve their level of communication and the level of care they are able to provide their patients. Independent physicians should also focus on taking the time to provide very specific, clear instructions when prescribing new medications or sending patients for follow up labs and tests. Diagnoses, especially, should be explained in detail to patients who are concerned about next steps and their overall prognosis. Communication builds trust, which helps independent physicians provide higher quality care. Spending more time with a patient during a visit, encouraging follow up questions after the visit, actively listening to the patient, and initiating conversations can greatly improve the level of communication, the level of trust, and the level of care.

Nick Dealtry
October 12, 2017

Read

Electronic health records (EHRs) for primary care physicians

A primary care physician is responsible for patient care, practice management, coordination with other providers, and many other activities throughout the day. The practice may also fall under the requirements of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its associated Merit-based Incentive Payment System (MIPS). With so many areas of the practice to manage, the independent physician needs a tool such as the electronic health record (EHR) to make everything run more smoothly and efficiently. Many primary care physicians are already taking advantage of the many functions EHRs have to offer them. The Office of the National Coordinator (ONC) for Health Information Technology (IT) states that as of July 2017, “354,395 ambulatory primary care physicians, medical and surgical specialists, podiatrists, optometrists, dentists, and chiropractors” are participating in the Medicare EHR Incentive Program. Additionally Health IT reports that, as of 2015: 64% of physicians had an electronic health record (EHR) with the capability to exchange secure messages with patients 63% of physicians had the capability for their patients to electronically view their medical record 41% had the capability for patients to download their medical record 19% had the capability for patients to electronically send (transmit) their medical record to a third party 16% of all physicians had the capability to provide all three functionalities - view, download and transmit - to their patients. Primary care physicians quite often have a need to collaborate with specialty physicians, laboratories, and healthcare facilities to provide coordinated care for their patients. EHRs also help with this function, as they enable all providers caring for a patient to see the same information about that patient. EHRs enable the primary care physicians to enter and view patient information in real-time, so the potential for errors, duplications, or missing information is significantly reduced. EHRs help primary care physicians do their jobs and more importantly, enable them to provide the highest quality healthcare to their patients.

Tyler Comstock
October 10, 2017

Read

What is the national quality forum (NQF)?

Primary care physicians recognize the need to provide quality care to their patients. The challenge for them comes when they are required to measure and report that quality. With the shift toward value-based care, in particular, the administrative burden for reporting has increased for independent physicians. Provider organizations are working to help alleviate some of the burden, or at least make the reporting requirements make a little more sense. One of those organizations is the National Quality Forum (NQF). The NQF states that its mission is to “lead national collaboration to improve health and healthcare quality through measurement.” A recent HealthAffairs Blog post described the NQF as an organization that “is addressing physician concerns about measuring what matters on multiple fronts.” When quality reporting requirements are tied to payments, often the independent physician faces the challenge of balancing the administrative tasks with the need to focus on patient care. As HealthAffairs Blog reports, the NQF is “uniquely positioned to prioritize the measures we should use to improve patient care, to identify and reduce measures of lesser value, and to align and harmonize the use of good measures across care settings, payers, physicians, and other clinicians.” The NQF was established in 1999 by a coalition of public- and private-sector leaders as a result of a recognition that such an organization was necessary to “promote and ensure patient protections and healthcare quality.” The organization is also focused on advocating for independent physicians by reviewing and recommending measurements and reporting requirements. In July 2016, the organization implemented a strategic plan “to lead, prioritize, and collaborate to drive measurement that can result in better, safer, and more affordable healthcare for patients, providers, and payers.” The plan moves the NQF to a “future, proactive state where we also lead and contribute to: accelerating development of needed measures; identifying priority measures; reducing, selecting, and endorsing measures; driving more effective implementation of priority measures; and better understanding what works and what doesn’t work in measurement.

Parker Nieves
October 9, 2017

Read

Clinical First EHR features: Collaborative Health Record

The Centers for Disease Control and Prevention (CDC) provides data for adults who visit a physician’s office each year in the United States. For last year, the CDC data shows the: Percent of adults who had contact with a healthcare professional in the past year: 83.6% Of those visiting a physician office, the percent of visits made to primary care physicians: 53.2% A significant percentage of patients typically visit specialty providers in addition to their primary care provider. As part of their care, they may also have lab tests, medical procedures, and possibly healthcare facility stays. The independent primary care provider must be able to communicate seamlessly and securely with all providers treating the patient. The provider must also have timely access to lab results and prescriptions for that patient to care for the patient properly. This crucial coordinated care is made possible through Elation’s Collaborative Health Record (CHR), an innovative feature of the Clinical First EHR. CHR enables all physicians caring for a patient to see all records pertaining to that patient, with on-demand access. The independent primary care provider no longer has to waste precious time calling for records and waiting for faxes. CHR automatically shares updates from the Clinical First EHR. Time and accuracy are imperative when caring for patients, especially those patients with chronic or complex conditions who must see specialty providers, so that all providers involved can provide the highest quality of care to those patients. Mistakes in medication or errors based on a lag in receiving test results can have severe consequences. The CHR enables all providers to get immediately notified so they can take action based on the most up-to-date clinical information. In addition, the CHR enables the independent primary care provider to get visibility into the patient’s complete care record for more accurate reporting on clinical quality measures and compliance for value-based reimbursement.

Parker Nieves
October 3, 2017

Read

Reasons why physicians choose not to retire

There is a growing fear of a primary care physician shortage in the US, given that medical students are choosing specialty areas in higher numbers and many independent physicians are aging out of daily practice. However, there is evidence that many primary care physicians are choosing not to retire at an age that has been considered to be a traditional retirement age. Hanover Research conducted a study to determine why physicians retire - and why they choose not to do so. They surveyed “more than 400 late-career physicians age 50 and older in various specialties, including psychiatry, emergency medicine, OB/GYN, surgery, and primary care.” They found that physicians tend to retire around age 68, whereas 65 is the age at which most American workers retire. The survey found that that the three most common reasons that physicians choose not to retire are: Enjoyment of the practice of medicine Social aspects of work A desire to maintain their existing lifestyle Of those reasons, the lack of a social life after retirement appears to be the influencing factor. The “loss of the social dynamic of the work environment tops the list of greatest retirement concern for respondents, followed by loss of purpose, boredom, loneliness, or depression.” The social interaction physicians enjoy at work is rewarding for many of them, including communicating with other physicians and patients, and they will miss that, according to the survey, more than even their income. The survey participants were of an average age of 60 and felt they still had quite a bit to contribute to their practices. In fact, “91 percent of respondents say they can still provide useful services to their patients and the community and 89 percent said they can still be competitive in the healthcare field.” Elation Health supports independent physicians throughout their careers by providing the tools they need to strengthen their relationships with patients and to provide phenomenal care for everyone.

Tyler Comstock
October 2, 2017

Read

AAFP selects a new president

The new president of the American Academy of Family Physicians (AAFP) opened his first speech with words of wisdom about family physicians listening to their patients. Michael Munger, M.D., of Overland Park, Kansas, said that engaging with patients is what family physicians do. “It's what separates us from many specialties," said Munger. Dr. Munger was addressing AAFP's 2017 Family Medicine Experience (FMX) in San Antonio, just hours after being named the new president of the organization. With over 31 years of experience, Dr. Munger started out as an independent physician and worked in his own practice for 16 years. Now he travels the country, listening to other family physicians and relaying their concerns back to the AAFP board. Some of those concerns involve the interoperability of electronic health records (EHRs). Dr. Munger noted in an interview that the lack of interoperability “really is one of the biggest challenges” that “leads to fragmentation and to the potential for gaps in care.” Dr. Munger also plans to address other major issues facing primary care physicians, such as administrative complexities and payment reform. Dr. Munger has been involved with AAFP since the beginning of his career. In addition to his concern for patients, some of whom have been with him for his entire 31-year career, he is also focused on helping family physicians who may be facing burnout. Part of his mission as the new AAFP president is to “work on the drivers that lead to physician burnout; identifying solutions will remain at the top of the AAFP's priority list.” Regarding the continuing national issues of healthcare coverage plans, Quality Payment Plans, and value-based reimbursements that are causing headaches for many family physicians, Dr. Munger emphasizes that AAFP is a “bipartisan membership organization.” He adds that he and AAFP “will continue working to reduce administrative complexity in medicine and will keep pushing our messages out about the value of primary care.”

Roy Steiner
October 2, 2017

Read

AAFP says proposed 2018 Medicare Physician Fee Schedule underpays primary care physicians

In July 2017, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule addressing “changes to the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies.” CMS encouraged input and feedback in regard to their proposed rule, with comments due in September 2017. In response, the American Academy of Family Physicians (AAFP) submitted a 40-page letter to CMS Administrator Seema Verma, M.P.H., which was signed by AAFP Board Chair Wanda Filer, M.D., M.B.A. In the AAFP letter, the organization pointed out some things in the CMS proposal that were positive and made some suggestions for changes, “for the good of family physicians and their patients.” The AAFP stated that it “continues to look out for the interests of family physicians in independent practice and noted this fact in its strong support of CMS' efforts to align payment policies for independent practices with those for practices owned by hospitals.” On page one of its letter, AAFP “blasted CMS for its proposed 2018 Medicare conversion factor of $35.99 -- an increase of just 10 cents from the 2017 conversion factor” and continued to comment that the “ongoing undervaluation of primary care services in the fee schedule will be perpetuated in the new MACRA quality payment programs if the agency does not urgently act to mitigate and correct these longstanding imbalances.” CMS also invited stakeholders to make suggestions as to how it could simplify regulations and policies. AAFP responded that it is “continuously working to alleviate demands placed on family physicians through entangling paperwork and needless regulatory complexities” and made a number of other suggestions, including: Placing the burden of electronic health record (EHR) interoperability on vendors rather than physicians Reducing documentation requirements for chronic care management Enhancing EHR and health information exchange in the provision of transitional care management services.

Roy Steiner
September 22, 2017

Read

Study shows primary care access to decrease STIs among women

The number of sexually transmitted infections (STIs) continues to result in significant healthcare costs for the US system. In addition, STIs can often lead to other healthcare issues for patients and, if not caught early enough, can be spread to others unknowingly. The Centers for Disease Control (CDC) released the following data for new cases of each STI known to occur in 2015: Number of new syphilis cases: 74,702 Number of new chlamydia cases: 1,526,658 Number of new gonorrhea cases: 395,216 A study recently published in Sexually Transmitted Diseases found that the rate of STIs among women actually decreases when those women have access to primary care services. The group conducting the study collected data on 666 women living in southern states in the US. They focused on data around the women’s HIV-seropositive and HIV-seronegative status. The researchers in the study, including Danielle F. Haley, PhD, MPH, of the University of North Carolina at Chapel Hill and Institute for Global Health and Infectious Diseases, found that “70% of the participants were HIV-seropositive, and 11% had an STI. A four-unit increase in the percentage of participants with a primary care provider yielded a 39% lower risk for STIs.” Primary care physicians who provide regular screening services can help reduce the number of STIs among their patients. The study found that those women who did not have access to primary care, even if they had lower risk factors, experienced a higher rate of STIs. Collaboration with other physicians may also be necessary to fully treat STIs and other conditions caused by STIs, but the diagnosis can happen during the primary care physician visit. Recognizing that independent physicians may need some guidance in speaking to their patients about STIs, the National Coalition for Sexual Health recently published Sexual Health and Your Patients: A Provider’s Guide, as an educational guide for physicians and their patients.

Parker Nieves
September 19, 2017

Read

What is the difference between family medicine and general internal medicine?

Medical terminology can be confusing, to patients as well as to providers. Even the descriptions of certain medical practices can be used interchangeably, and incorrectly, without some clarification. Primary care physicians generally fall into one of two categories, they are either in a family practice or they practice internal medicine. What’s the difference? Essentially, a primary care physician in a family medicine practice sees patients of all ages, treating adults and children alike. The family care physician also treats men and women for conditions specific to each sex. As the American Academy of Family Physicians (AAFP) states, family medicine “encompasses all ages, both sexes, each organ system and every disease entity.” Family medicine is a relatively recent designation. First used in the 1960s, it was officially recognized as a medical specialty in 1969. Although the majority of medical students still tend to choose other specialties within internal medicine, the number of primary care physicians in family medicine has been showing an increase in recent years. Internal medicine is more focused than family medicine. The primary care physician practicing internal medicine sees only adults, for diagnosis and treatment. To complicate the clarification a bit, even though primary care physicians can practice general internal medicine, not all internal medicine is primary care. There are many subspecialties within internal medicine, including primary care as well as cardiology, endocrinology, and geriatric medicine, to name just a few. Elation Health supports the primary care physician in both family medicine and internal medicine. Our focus is on providing the tools the independent physician needs to provide quality healthcare for their patients in an efficient and effective manner. Our electronic health record (EHR) solution is designed and developed to be an interactive, intelligent, and more predictive tool, allowing physicians to collaborate and coordinate care for the best possible patient outcomes.

Nick Dealtry
September 18, 2017

Read

The impact of integrated, collaborative primary care on the opioid epidemic

In 2015, there were 52,404 lethal drug overdoses in the US. Out of that number, 20,101 were related to prescription pain relievers and 12,990 were related to heroin, reports the American Society of Addiction Medicine (ASAM). The organization also states that “23% of individuals who use heroin develop opioid addiction.” Only a small percentage of the 20.5 million people in the US over the age of 12 who had a substance use disorder received treatment in 2015. A study conducted by Katherine E. Watkins, MD, MSHS, Allison J. Ober, PhD, and Karen Lamp, MD, and published in JAMA Internal Medicine, focused on how collaborative care could impact the treatment of those with an opioid or alcohol use disorder. The study, “Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care,” found that “relative to usual care, the collaborative care intervention increased both the proportion of primary care patients receiving evidence-based treatment for opioid and alcohol use disorders and the number achieving abstinence from opioids or alcohol use at 6 months.” Pointing to a need for collaborative care based in the primary care provider’s office, results from the study showed that “39% of patients treated in a collaborative primary-care model received addiction treatment versus just 17% of the group who received standard primary care.” Addiction or substance abuse treatment has typically been sought and provided at a disorder treatment program. Given the current state of the opioid epidemic, the need for primary care physicians to coordinate with multiple providers to treat the patient with an opioid disorder is clearly noted in the study results. In addition to providing treatment to more patients as well as more effective treatment, collaborative care also has long-term effects. In the study, “32% of patients in the collaborative model reported remaining abstinent from opioids or alcohol after six months compared to 22% of patients in standard primary care.”

Greg Miller
September 18, 2017

Read

Care coordination for rural independent practices

A physician’s ability to coordinate a patient’s care with other providers and healthcare facilities is becoming increasingly important. Those patients with chronic or complex conditions, in particular, benefit from a physician’s ability to coordinate their care with other providers. As the patient base ages, the number of chronically ill patients will increase. Patients in rural areas often do not have access to the same level of coordinated care as urban patients receive. A recent paper published by The Robert Wood Johnson Foundation points out that “rural areas often experience disparities in access to care, health status, and available infrastructure relative to their urban counterparts.” One of the challenges with rural care is the shortage of physicians. Often the primary care provider serves an entire county and may not have the resources to hire administrative staff to handle the paperwork often involved in coordinating with other healthcare providers. Physicians in rural areas who take advantage of tools such as electronic health records (EHRs), however, do have access to the ability to share patient information with other providers, regardless of their location. Specialty providers may not be located in the patient’s immediate rural area. In these cases, it is especially important for the primary care provider to have ready access to the patient’s medical records, visit notes, lab results, and other healthcare information. A significant amount of time and effort can be wasted waiting for information to be faxed or for phone calls to be returned. Likewise, those specialty providers need access to the primary care provider’s visit notes and patient concerns to be able to properly treat the patient. Elation’s Collaborative Health Record (CHR) enables providers in rural areas to communicate and to view patient information in real time, even when they are separated by some distance from each other. The CHR automatically share updates directly from the primary care provider’s Clinical EHR. Other providers get immediately notified so they can take action based on the most up-to-date clinical information. Care coordination is crucial for patients who are being treated by multiple providers. Those providers have the tools available to overcome the challenges facing rural independent practices.

Tyler Comstock
September 18, 2017

Read

Patient-Centered Primary Care Collaborative (PCPCC) lays out vision for primary care

In an effort to help move the future of healthcare toward being “person-centered, team based, and aligned with the community,” the Patient-Centered Primary Care Collaborative (PCPCC) has released its Shared Principles of Primary Care. PCPCC worked with Family Medicine for America’s Health (FMA Health) to develop the principles, collaborating on the goal of advancing healthcare in the United States. PCPCC states that these shared principles are “critical to both advancing policy that strengthens primary care in both the public and private sectors, and enhancing the practice and delivery of primary care within the healthcare system.” The PCPCC shared principles urge primary care to be: Person & Family Centered - primary care is focused on all aspects of the patient, including “physical, emotional, psychological and spiritual well being, as well as cultural, linguistic and social needs.” Continuous - primary care physicians develop quality and sustaining relationships with patients to ensure continuity of care, through to their end of life decisions. Comprehensive & Equitable - partner with “health and community-based organizations to promote population health and health equity, including making inequities visible and identifying avenues for solution.” Team Based & Collaborative - healthcare professionals work together with each other and with patients and their family members toward the goal of quality outcomes for the patients. Coordinated & Integrated - the primary care team works with everyone involved in the patient’s care, proactively communicating and navigating care plan options, to “achieve better health and seamless care delivery across the lifespan.” Accessible - primary care is accessible to all, regardless of status, background, or potential barriers; access to health information is also available to all patients. High Value - the primary care team delivers “exceptionally positive experiences” for patients and their families as well as for providers and practice staff. The PCPCC plans to use these shared principles in their advocacy efforts on Capitol Hill. More importantly, they envision organizations using these principles to ensure “a vibrant future of primary care.”

Parker Nieves
September 15, 2017

Read

4 keys to successful preventative care for Medicare physicians

In 2016, the Centers for Medicare & Medicaid Services (CMS) published the Quality Strategy that details its goals related to improving the quality of healthcare delivery. However, primary care physicians have found many of the new CMS quality measurements and requirements, established as a result of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, to be quite restrictive. The Quality Strategy mentions preventative care specifically in that one of the CMS goals is to enable more patients to have better access to quality care, particularly those patients with chronic illnesses. How can independent physicians successfully manage the need for their patients to have access to preventative care and the need for their practice to fully participate and receive CMS reimbursements for these services? Focus on the patient’s well-being. Know that preventative services are proven to be effective, as the Quality Strategy points out, in managing chronic diseases and in reducing the risk of cardiovascular disease. Obviously, the sooner a condition is diagnosed and treated, the higher quality the outcomes will be for the patient. Engage the entire team in the patient’s preventative care. As reported in a recent issue of Health Data Management, “support staff can own most of the legwork like the HRA, patient history, screenings and assessing for preventive services, to reduce the amount of physician time needed.” Take advantage of technology. Using the features of an electronic health record (EHR) system can greatly enhance the quality of care provided to the patient as well as the efficiency with which the independent practice operates. In fact, one of the CMS Quality Strategy foundational principles is to “use health IT (e.g., EHR and data management systems) to support the integration of clinical preventive services and community-based prevention strategies.” Involve patients in their own care. Empowering patients through communication and education can have a significant impact on the success of their preventative care in terms of healthcare outcomes. As the article in Health Data Management points out, “physicians can use the visits to help patients understand their own role in the management of their health.”

David Burke
September 8, 2017

Read

Factors that impact care coordination

Care coordination is of particular importance to primary care physicians. Patients are often referred to specialists, sent for tests, and prescribed medications by other physicians. A clear understanding of the patient’s total care profile is crucial for providing quality medical care to those patients. Often, however, care coordination by primary care physicians is lacking. There are a number of factors, according to recent research, that determine why better care coordination is given to some patients over others. A 2013 Commonwealth Fund International Health Policy survey was conducted of primary care patients in 11 countries, including the United States. The results showed the highest rate of poor primary care coordination to be in the medical field in the United States. The research provided some insight into the factors that impact care coordination. Survey results indicated that the “likelihood of poor primary care coordination was higher for patients with chronic conditions … and patients younger than 65 years.” Chronic condition patients benefit more from coordinated care Patients with chronic conditions experience the lowest rate of care coordination, yet this group is the population segment that would benefit greatly from just such coordination. Primary care physicians who treat chronically ill patients need to have a complete understanding of the patient’s specialty care visits, test results, and medications. The research also indicated that “the likelihood of experiencing poor primary care coordination was lower if the primary care physician often or always knew patient's' medical history, spent sufficient time, involved patients, and explained things well.”  Enhanced communication with other providers and with the patient can help optimize care coordination for all patients. An EHR system offers primary care physicians the opportunity to provide higher quality care coordination. Having immediate access to a patient’s complete medical history, including specialty visits, lab results, and medications, improves the provider-patient relationship and enables the primary care physician to optimize care coordination for that patient. At Elation, we are concerned about the quality of care coordination available to primary care physicians and your patients and we have developed the tools that will help make a difference for you.

Roy Steiner
September 8, 2017

Read

How primary care workforce trends impact patient care

There is much concern about the shortage of primary care physicians in the US today. The trend continues as more medical school students choose higher-paying specialty physician tracks. Christopher Barbey, Nikhil Sahni, Robert Kocher, and Michael Chernew recently examined the research, including the numbers and relevant studies, with the goal of understanding “the trends underlying the growth in the clinical workforce and their potential implications for health care spending, health policy, and health system design.” In their research, the team discovered that between 2005 and 2015, “the share of the physician workforce devoted to primary care actually decreased from 44 percent to 37 percent, and the number of primary care physicians per capita has remained roughly flat.” The decrease in primary care physician numbers means that patients may have less access to primary care. The research team found that the gap was being filled by physician assistants and nurse practitioners, however, and those numbers were actually increasing. Given this primary care workforce trend, the need for efficiency in practice management and for coordinated care becomes even greater. Primary care physicians who use electronic health records (EHRs) will find that they have more time to spend with their patients - giving patients greater access - as they will need to spend less time on paperwork. Coordinated care between physician assistants, nurse practitioners, specialty providers, and the primary care provider becomes even more important as more physician assistants and nurse practitioners see patients on the primary care provider’s behalf. Coordination in an EHR system enables all healthcare providers to understand the patient’s complete medical profile, including being able to view visit notes, medications, and lab results. Patient care may see a significant shift as the number of primary care physicians decreases and the number of physician assistants and nurse practitioners seeing patients increases. However, the quality of that patient care can remain consistent with the use of EHRs to provide coordinated care and efficient practice management.

Parker Nieves
September 8, 2017

Read

The difference between EMRs vs EHRs

The terms electronic medical record (EMR) and electronic health record (EHR) can be confusing and, in fact, are quite often used interchangeably. Although they have much in common, there are some significant differences. The term EMR was widely used before EHR technology became more prevalent among independent physicians. The Centers for Medicare & Medicaid Services (CMS), on its webpage describing Certified EHR Technology, adds a very brief note regarding the use of the term EMR. Acknowledging that some medical professionals use the two terms to mean the same thing, CMS states that “very often an Electronic Medical Record or EMR is just another way to describe an Electronic Health Record or EHR.” However, for the purposes of the CMS Incentive Programs, “eligible professionals, eligible hospitals and critical access hospitals (CAHs) must use certified EHR technology.” The Office of Health Information Technology (IT) clarifies the differences between the terms, saying basically that an EHR contains a little more information and is more accessible by multiple healthcare providers: Electronic medical records (EMRs) are digital versions of the paper charts in clinician offices, clinics, and hospitals. EMRs contain notes and information collected by and for the clinicians in that office, clinic, or hospital and are mostly used by providers for diagnosis and treatment. Electronic health records (EHRs) are built to go beyond standard clinical data collected in a provider’s office and are inclusive of a broader view of a patient’s care. EHRs contain information from all the clinicians involved in a patient’s care and all authorized clinicians involved in a patient’s care can access the information to provide care to that patient. EHRs follow patients – to the specialist, the hospital, the nursing home, or even across the country. A patient’s care is better coordinated through the use of EHRs in the primary care physician’s office, as the information can be shared with multiple providers, laboratories, and healthcare facilities.

Tyler Comstock
September 8, 2017

Read

The impact of EHRs during Hurricane Harvey

At Elation Health, we are deeply concerned about the impact that Hurricane Harvey has had on the people living in Texas and Louisiana. Residents have had to flee their flooded homes and seek shelter elsewhere. Assisted living facilities and nursing homes have had to transport their residents to safer locations. Healthcare facilities have had to evacuate their patients and find other providers for them, outside of the devastation area. Fortunately, many of the physicians attending to those patients still have access to their medical information. The Bloomberg BNA Healthcare Blog reports that most healthcare providers in the Houston area have adopted electronic health records (EHRs), “which has helped to support displaced patients and providers.” EHRs ensure that physicians and other providers continue to have access to critical medical information even if their facilities have been flooded out. Prior to the implementation of EHRs, medical records were kept on paper in a filing system. If those papers were lost or soaked in a flood, the patient’s information would be lost as well. EHRs enable physicians to coordinate care with other providers, a crucial need in times of disaster such as the devastation caused by Harvey. As the Healthcare Blog points out, those providers who are now seeing patients previously treated in hurricane-damaged areas “can have instant access to patient information such as allergies, active medications, and diagnostic imagery.” Physicians who take advantage of the features of EHRs are able to login from anywhere and manage their patients’ care, including sharing information with their new providers. Patients who have the capability to communicate electronically with their providers can also continue to access their information through EHRs, even when their providers’ offices may have been flooded or otherwise damaged. This continuation of care is particularly important to patients who are undergoing treatment or who have chronic or complex illnesses that need attention, even during a major storm such as Hurricane Harvey.

Nick Dealtry
September 7, 2017

Read

Study shows primary care appointment availability changes after the ACA

Many in the healthcare field predicted that when more people gained health care coverage, the demand for primary care appointments would increase significantly as more people had the resources available to be able to visit a doctor for basic preventative care. This thought process also contributed to the overall concern that there were not enough primary care physicians to accommodate all of the new patients who would be covered under the Affordable Care Act (ACA). However, a study published in April 2017 shows some surprising results. JAMA Internal Medicine published “Changes in Primary Care Access Between 2012 and 2016 for New Patients With Medicaid and Private Coverage,” which described a study conducted in 2012-2013 and then again in 2016 to determine how the ACA impacted primary care appointment availability. Primary care practices in Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas were studied. The report describes appointment availability increasing for Medicaid patients overall between 2012 and 2016, although the specific numbers differ by state. Appointment availability for patients with private insurance essentially remained steady, with some states seeing increases and some decreases. Wait times for appointments increased somewhat for Medicaid patients as well as for those patients with private insurance. A number of factors may come into play in regard to the appointment availability results. Medicaid incentives may have encouraged more primary care physicians to accept Medicaid patients. In addition, better practice management on the providers’ part may have helped them become more efficient and able to see more patients. The report states that factors such as data sharing, in the form of collaborative electronic health records (EHRs) for example, may also have contributed to the primary care providers’ ability to expand their capacity and provide more appointment availability. As the JAMA report states, the appointment availability results found in the study “should ease concerns that the Affordable Care Act would exacerbate the primary care shortage.”

Parker Nieves
August 31, 2017

Read

What is patient-focused care?

The second listed goal in the Centers for Medicare & Medicaid Services (CMS) Quality Strategy is “Strengthen persons and their families as partners in their care.” The strategic result for this goal is that “Persons and families are engaged as informed, empowered partners in care.” Further the Strategy cites the Institute of Medicine’s explanation of patient-centered care as being “respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” For independent primary care physicians, it may seem obvious that they should be focused on patient care. That is, after all, what they are tasked to do and what they deem to be their calling, to focus on their patients’ healthcare. Patient-focused care, however, takes a slightly different approach to the independent primary care practice than may have been seen in traditional practices. The CMS Quality Strategy explains that, according to the National Quality Forum, patient-centered care is focused on “collaborative partnerships among individuals, their defined family, and providers of care. It supports health and well-being by being consistent with, respectful of, and responsive to an individual’s priorities, goals, needs, and values.” Patient engagement is a crucial element in patient-focused care. Involving the patient and the patient’s family in crucial decisions can empower the patient to be more vigilant in regard to medications and follow-up visits. Patients who are encouraged to communicate with the primary care physician during and after the visit tend to be more vested and more active in their own healthcare plan, benefiting the patient and the provider. In patient-focused care, the patient is given more control over care decisions. The primary care physician does not simply give the patient a diagnosis and instructions for a care plan. Rather, the diagnosis is thoroughly discussed with the patient and the patient’s family, where appropriate. Being informed about all aspects of the diagnosis and the treatment plan, and having a part in the decision-making around that plan, the patient is able to be more responsible and more responsive.

David Burke
August 31, 2017

Read

Mastering patient communication as a primary care physician

In a poll recently conducted by Pew Research Center, a significant majority of patients were pleased with their healthcare providers. However, 15% of those who had seen a provider in the year prior to the survey “felt confused about instructions they got for treatment or at-home care.” Improved communication with the patient during and after the visit is crucial in these situations, when a patient’s healthcare outcomes may depend on their ability to continue their treatment plan after the visit. How can the independent primary care physician master that critical patient communication piece of providing quality healthcare? The first step is to take the time to focus on engaging the patient. During the visit, listen to the patient’s concerns and address them as fully as possible with a clear, concise response. Allow the patient to ask questions, particularly as they concern a diagnosis, necessary tests or medications, or a proposed healthcare treatment plan. Provide additional information regarding the diagnosis, tests, or medications, with brochures, flyers, or printouts from professional research sources. Take the time to point out relevant areas of the literature that pertain specifically to that patient. Again, encourage questions and clearly explain the answers, checking to see if the patient truly does understand all of the information provided. When communicating electronically, avoid the use of acronyms, abbreviations, or vague language that will not be clearly understood by a patient who has not been immersed in the language of the industry. Professionals in all industries tend to communicate using terms that are specific to their field that are not generally understood by others. Avoid the use of emoticons or emojis in electronic communications. Reassure the patient that all communication, whether face-to-face or online, is safe and secure. This will build trust with the patient that enables the patient and the primary care physician to communicate more effectively. Communication is a crucial piece of the patient’s healthcare plan. Primary care physicians can master patient communication, by taking a little extra time and focusing a lot more on each patient during and after the visit.

David Burke
August 25, 2017

Read

5 reasons why Elation is the best EHR for primary care

Besides creating the industry’s first ever Clinical First EHR that truly supports the doctor-patient relationship, Elation has been dedicated to becoming the leading EHR system for primary care physicians. We have vowed to be excellent in serving the needs of primary care providers everywhere. To show you we mean it here are 5 reasons why Elation has the best EHR for primary care: 1. Clinical First Focus Clinical First is a commitment to building a provider-centric Clinical First EHR that exists at the nexus of the clinical workflow, supports the physician-patient relationship, and drives outstanding patient outcomes. 2. Elation’s Cockpit View The Cockpit View shows everything you need in a unique three-pane console, giving you complete flexibility in how you deliver care. Chart, e-prescribe, and order lab tests all from the same screen. Eliminates the back-and-forth linear workflow — letting you click less and have more face time with patients. 3. Comprehensive Clinical Insights You can automate data entry with a Dynamic Problem List. Chart visits with a collection of notation templates, including free text and dictation support, so you can chart the way you want. Use the Smart Visit Note to automatically record your actions during a patient visit. You can pull in specific information from a previous visit with just one click. We’ll organize results with their correlated problem to help save you time when charting. 4. Collaborative Longitudinal Care Trend values and track outcomes for a comprehensive overview of your entire patient panel. You can quickly find data and take action, all within the same window. Uninterrupted communication allows you to decrease duplicative testing and avoid medication errors. Timely sharing of patient information with the Collaborative Health Record helps to ensure patient care is as efficient and as effective as possible. 5. Drive Patient Engagement Send and receive messages with your patients to engage them beyond their visit. All of your communication histories are automatically linked to the patient’s chart and are easy to find. Elation enables you to securely share vitals, lab results, and visit summaries through our HIPAA-compliant patient portal; so you know your patient’s sensitive information is safely shared and stored. Experience Elation for yourself and see why providers love us! Contact us to learn how intuitive and easy-to-use a Clinical First EHR can be.

Tyler Comstock
August 25, 2017

Read

Small incentives could encourage more patients to seek out primary care

Access to a primary care provider can make a significant difference in the health of the patient. Benefits have been proven to include improved healthcare results, reduced costs, greater coordinated care, and more effective integrated services. However, having access does not always guarantee that the patient will actually visit the physician. Lower income patients, especially, may be hesitant to visit their primary care provider. A number of studies have been conducted to determine why these patients do not visit their primary care physicians and whether financial incentives could actually encourage them to do so. Lower income patients may not want to make that initial primary care visit out of a fear of the additional costs involved, both at the primary care provider’s office and at any special provider, laboratory, or healthcare facility that may be recommended as part of their coordinated care. Cathy Bradley, Ph.D., and David Neumark, Ph.D., conducted a study recently in which lower income patients were offered an incentive of up to $50 to visit their primary care provider. Some study participants were not offered any incentive, beyond the initial $10 to complete a telephone survey. According to an article published by AAFP, “Seventy-seven percent of individuals who received $50 completed a primary care appointment within six months. The rate dropped to 74 percent for those who received $25 and to 68 percent for those who received $0.” Previously, in 2011, a similar incentive program that was funded by the Centers for Medicare & Medicaid Services (CMS), “to test financial incentive programs to encourage healthy behavior among Medicaid enrollees with chronic diseases,” found mixed results. That study found that incentives were more effective with encouraging patients to access preventative care for a single event, such as an immunization, rather than for ongoing primary care services. For most patients, a visit to the primary care physician can be the beginning of a quality healthcare plan that includes building a positive relationship with the provider, communicating with that provider about healthcare concerns, and following the primary care provider’s guidance for improved health outcomes.

Greg Miller
August 25, 2017

Read

Chronic conditions and primary care

Patients with chronic conditions typically are seen by multiple providers. For example, a person diagnosed with diabetes may need to see an endocrinologist, a dietitian, and an eye care specialist, as well as undergo lab tests and stays in healthcare facilities. Coordinating and managing this patient’s care is best accomplished by the patient’s primary care physician. In fact, in the case of patients diagnosed with diabetes, the primary care physician may provide most of the direct care for the patient. The National Institute of Diabetes and Digestive and Kidney Diseases reports that, although “endocrinologists or other diabetes specialty physicians are involved in caring for many people with diabetes, primary care physicians provide more than 80 percent of diabetes care.” A primary care physician is able to coordinate care, collaborating with the patient’s specialty providers, to ensure that the patient with a chronic condition receives consistent, quality healthcare. Without such collaboration, each provider, laboratory, and healthcare facility is working in a silo-like environment. The potential increases for duplication, particularly with lab tests and medications. More importantly, the potential for errors also increases, when providers are not communicating with each other regarding the patient’s plan of care. Communication with the patient and with other providers is extremely important for the primary care physician in the treatment of a patient with a chronic condition. Relying on the patient’s memory or waiting on paperwork from other providers can create serious issues and add to the complications of the patient’s overall health care. A tool such as Elation’s Clinical First EHR enables the primary care physician to seamlessly and securely coordinate care for patients with chronic conditions. Visit notes, laboratory results, medication orders, and specific patient information are all available with just one click. The primary care physician is also able to identify patients who aren’t meeting goals based on custom care management protocols, Meaningful Use objectives, or specific document tags, and easily schedule a follow-up appointment to address any potential gaps in care.

Parker Nieves
August 24, 2017

Read

What is collaborative care?

One of the goals of the Centers for Medicare & Medicaid Services (CMS) Quality Strategy is to “strengthen persons and their families as partners in their care.” A major emphasis within this goal is the need for “collaborative partnerships among individuals, their defined family, and providers of care.” Medical care is very rarely about one provider treating one patient in a silo-like environment. To be truly effective, collaborative care is generally always a factor in a patient’s healthcare plan. What is collaborative care? Quite simply, it is the result of multiple providers communicating with each other about a patient’s diagnosis and treatment. When a primary care physician’s patients see specialty providers, undergo tests or procedures, or stay in healthcare facilities, the notes and results from those visits must be shared so the providers involved in the care can collaborate. Collaborative care also happens between patient and physician and between physician and the patient’s family. In cases where other factors, such as family history, social environment, or mental status, can impact a patient’s health, the primary care physician must be able to gather the whole picture to treat the patient effectively. Patients with chronic or complex conditions, especially, need collaborative care to ensure that their healthcare plan is properly coordinated between multiple providers, laboratories, pharmacies, and healthcare facilities. What are the benefits of collaborative care? Brennan Bosch and Holly Mansell, BSP, PharmD, write that collaboration “has been shown to improve patient outcomes such as reducing preventable adverse drug reactions, decreasing morbidity and mortality rates, and optimizing medication dosages.” When multiple providers treating a patient do not collaborate on the care plan, the opportunities for duplications and errors increase, possibly with severe consequences. Elation Health’s Collaborative Health Record provides primary care physicians on-demand access to patient information from any provider in the network. Time spent faxing referrals, requesting records, or chasing down lab results is virtually eliminated - a crucial element in effective collaboration. CHR automatically share updates directly from the physician’s Clinical EHR, so other providers get immediately notified, enabling them to take action based on the most up-to-date clinical information.

Nick Dealtry
August 24, 2017

Read

6 tips for succeeding during the shift to value-based care

Primary care physicians are challenged with running an effective practice, providing quality healthcare to their patients, and, now, shifting their practice model from fee-for-service to value-based care. Although independent primary care providers have always been concerned, first and foremost, with the well-being of their patients, value and its measure in the new model will require some effort. Atlantic Health System CEO Brian Gragnolati has offered some tips for primary care physicians, to help them succeed as they shift to value-based care. Avoid patient harm. Measuring readmission, mortality and HAIs (healthcare associated infections) will enable the independent physician to focus on preventable harm “and the need, where appropriate, for pre-emptive intervention, such as precautions against falls, pressure ulcers, and line management.” Measure what affects your ability to get paid. Independent physicians who use electronic health records (EHRs) are able to view patient records and identify patients who aren’t meeting goals based on custom care management protocols, Meaningful Use objectives, or specific document tags, and easily schedule a follow-up appointment to address any potential gaps in care. Interoperability between EHRs is also a key factor here. Consider patient experience. Integration and coordination with other physicians and healthcare facilities increases the value for the patient and the provider. As Gragnolati points out, “with affordability a top concern to consumers, value has to be a part of the equation from their point of view.” Measure employee engagement. Given the focus on patient engagement, independent providers may not take the time to ensure their teams are engaged as well. Ensuring that staff understands the practice’s role in general, as well as each individual's role in the patient's care, can significantly improve the value of that care. Conduct patient care huddles. A patient huddle involves the entire staff in discussing and reviewing care plans for the practice’s patients each day. Build credit strength. The independent physician needs to stay on top of the practice’s financial health as well as the patients’ health, reviewing the balance sheet regularly and ensuring that it is “completely connected to its profit and loss statement.”

Kimmy Hu
August 22, 2017

Read

What is the relationship between ACOs and value-based care?

The Centers for Medicare & Medicaid Services (CMS) describes Accountable Care Organizations (ACOs) as “groups of doctors, hospitals, and other healthcare providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.” Independent physicians may participate in an ACO as an option for the Alternative Payment Model. What is the relationship between the ACO structure and the current transition toward value-based care? CMS is encouraging a move to value-based care and away from the fee-per-visit reimbursement model. The concept of value-based care emphasizes patient outcomes rather than the quantity of patient visits. Physicians who participate in ACOs are able to coordinate with other physicians in the group, spending their healthcare dollars more wisely, and realizing better cost-savings. As a result, they are able to provide higher quality care at lower costs. As CMS describes them, ACOs are “patient-centered organizations where the patient and providers are true partners in care decisions.” Coordinated care and patient engagement are significant factors in the independent physician’s ability to provide value-based care. When patients become more involved in their own healthcare plan, they are more likely to see higher quality outcomes. Coordinated care can result in fewer duplications and errors, improving the quality level of the care provided to each patient. For patients with chronic or complex conditions, the independent physician’s ability to coordinate with other providers is a crucial element of the patient’s healthcare strategy. Moving forward with its value-based care initiative, CMS has introduced the Next Generation ACO Model, which offers “a new opportunity in accountable care—one that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.” The Next Generation model is designed for those ACOs with more experience in coordinating care for populations of patients.

Greg Miller
August 22, 2017

Read

Mastering patient engagement for primary care physicians

Patient engagement is a key part of a primary care physician’s role and there is always room for improvement, especially with the technology we have access to nowadays. Research has shown that a patient’s engagement in their care can lead to significant progress in healthcare safety and quality. Being more informed about your own health gives you more control over it and the engagement with your primary care physician keeps you more connected to the care you are receiving. Resources used to increase patient engagement efforts Patient engagement goes hand in hand with patient management, meaning making appointments, referrals, prescriptions and refills, lab exams and tests. These are all part of your patient management duties. To be able to do all of these things more efficiently making it easier to engage with your patients, you will need an Electronic Health Record (EHR) system. EHRs make it easier to manage your administration duties while engaging with your patients. Using tools such as OpenNotes, which gives patients access to their medical records so they can read their doctor’s visit notes; can help your patients stay up to date with their health care goals. Patients can access the visit notes online through the patient portal or in hard copy from a printout. Using team-based care is a transformative method of delivering care that focuses on teamwork. In addition to the patient and family, a patient’s care team may include a doctor or nurse practitioner, RN, care team coordinator, and even a pharmacist or social worker. Having all of these healthcare providers involved in a patient’s care can improve patient engagement, safety and quality when appropriate care coordination is being exercised. Having a messaging system within your EHR allows patients to connect with you if they have any questions or concerns about their health, appointments, lab results or prescriptions. Having this feature makes physicians more accessible to their patients which creates more patient engagement. Using a tool such as Elation’s Patient Passport gives patients a way to connect with their physicians and be able to see their critical health information without having to visit the doctor's office. The Patient Passport is integrated with a messaging system, as well as giving patients access to their critical health information such as allergies, problems, history, visit summaries, current medications, immunizations, legal and specialists. This information is here for any patients who want to be more informed as to what is going on with their health and so that it can be shared with other clinicians who would find it helpful to facilitate care.

Nick Dealtry
August 22, 2017

Read

Most Americans have high satisfaction rates for their physicians

The healthcare environment in the US today is in flux as changes to the Affordable Care Act (ACA) and proposed new policies have been debated and rejected. A physician shortage looms over the primary care field. Physician burnout is on the increase. Healthcare costs are rising. However, there is good news! A recent poll conducted by the Pew Research Center has found that “the public continues to hold healthcare providers in high regard.” The survey, conducted in the spring of 2016, found that 87% of those patients who had seen a healthcare provider in the previous year felt that “their concerns or descriptions of symptoms were carefully listened to, and 84% say they felt their provider really cared about (their) health and well-being.” In addition, 80% felt “their doctor really cared about their health/well-being.” With the emphasis on value-based care, and the movement away from fee-for-service reimbursement, primary care physicians are finding that these quality numbers are becoming more important. Patient engagement is crucial to improved healthcare outcomes, benefiting the patient and the practice. On the downside, 23% of those surveyed felt that they were “rushed by their healthcare provider.” 15% “felt confused about instructions they got for treatment or at-home care.” While these numbers are encouraging, communication with patients during and after the visit can help increase the number of patients who clearly understand instructions for how they are to continue their own care at home. In addition, the use of technology tools such as electronic health records (EHRs) can give the primary care physician more time during the visit to focus on and listen to the patient. The EHR provides the primary care physician immediate access to previous visit notes, lab results, and data input by other providers caring for the patient. The independent primary care physician can spend more time with the patient and less time on paperwork and other distractions.

Kimmy Hu
August 21, 2017

Read

The impact of greater access to primary care

Access to primary care can make a huge difference to individuals as well as to the healthcare system overall. Having a primary care physician as a base for healthcare services enables a patient to build trust with that physician. In turn, patient access enables the physician to more effectively coordinate services and provide the overall healthcare needed by each patient. According to the Institute of Medicine, Committee on Monitoring Access to Personal Health Care Services, access to healthcare means "the timely use of personal health services to achieve the best health outcomes.” Greater access to primary care impacts a number of health outcomes, including: Communication. When a patient has access to a primary care physician, that patient also has access to communication with the physician, before, during, and after the visit. Particularly when the primary care physician uses a tool such as an EHR system, communication is secure and seamless. Coordinated care. Patient access to a primary care physician means that patient has someone to coordinate care between specialty providers, labs, pharmacies, and healthcare facilities. Duplication and errors are greatly reduced and, in some cases, completely eliminated through improved coordination. Reduced costs. The healthcare system overall sees reduced costs when patients have greater access to primary care. According to Health is Primary, a recent study has shown that “every $1 invested in primary care leads to $13 in savings.” Integrated services. In addition to coordinating care with specialty healthcare providers, primary care physicians can also integrate healthcare services with additional providers such as mental health or social services. Improved patient health. Access to a primary care physician can help the patient and the physician focus more on preventive medicine. Keeping healthy patients healthy is a key priority for independent primary care physicians as well as for their patients. Developing a relationship with a primary care physician is important to a patient’s overall health. Access to primary care is an essential first step in building that relationship, maintaining the patient’s health, reducing or eliminating expenses and errors, and keeping the costs down in the healthcare system in general.

Nick Dealtry
August 15, 2017

Read

Making reporting less burdensome for primary care physicians

While the government implements the Medicare Access and CHIP Reauthorization Act (MACRA), many feel as though the quality measure reporting for primary care needs to undergo an update. Primary care has been described as a complex system with patients who have different backgrounds and needs. The priorities for primary care quality management range from patient-centered reporting; quality goals not based on rigid targets; metrics that capture avoidance of excessive testing or treatment; attributes of primary care associated with better outcomes and lower costs; and many others which cannot be fit into a one-size-fits-all quality measures box. In March, the National Quality Forum’s Measure Applications Partnership said federal agencies should take out several healthcare performance measures. MAP usually offers the Department of Health and Human Services new or improved measures  to consider adding to the existing measures. However, last month the group contemplated older performance metrics and determined which ones the agency could potentially eliminate due to the inability to provide information that would lead to meaningful care improvements. They suggested removing 51 of 240 measures that are included in seven federal programs used to determine payment; also offering recommendations to improve the performance measures in nine federal programs. Suggestions for improving performance measures MAP's goal is to reduce the administrative tasks on providers and to ensure that the government applies the most useful performance metrics to measure quality. Primary care physicians are often overwhelmed with paperwork and other uncompensated administrative duties, which contributes to burnout, stress and job dissatisfaction. The Centers for Medicare & Medicaid Services have since launched a program to tackle the issue. Elation Health prides itself on being the best Clinical EHR for Direct Primary Care with our Clinical First platform aligning with your unique practice goals. Request a demo and speak with one of our Practice Specialists to learn more about how Elation can work for you!

Greg Miller
August 14, 2017

Read

What studies say about patient-centered medical homes (PCMHs)

The patient-centered medical home (PCMH) structure enables the primary care physician to provide continuous and coordinated care to patients from a home base. All of the patient’s healthcare needs, including preventative services, diagnosis and treatment of illnesses, and even end-of-life care, are arranged for from within the PCMH. The idea behind the concept is that a primary care provider who sees a patient for essentially everything throughout the patient’s life span can provide higher quality, value-based healthcare to that patient. Approximately 45 percent of family physicians now practice under the model, within a medical home. In July 2017, the Patient-Centered Primary Care Collaborative (PCPCC) released a report that looked at the link between these PCMH practices and quality outcomes for their patients. The report, The Impact of Primary Care Practice Transformation on Cost, Quality, and Utilization, was the sixth annual edition, authored by the Robert Graham Center of the American Academy of Family Physicians and published with support from the Milbank Memorial Fund. PCPCC studied 45 peer-reviewed reports and additional government and state evaluations, to determine the impact of PCMHs on the quality of patient outcomes. The report “found decreased costs and better results in more mature initiatives and for patients with more complex conditions.” Some of the practices included in the study were relatively new, with only one or two years of experience as a PCMH; however, the report found that “gradual changes to the model have demonstrated improvement in the patient experience.” The PCMH model provides higher quality coordinated care and communication for the patient. The structure enables the primary care physician to develop a long-term relationship with the patient as well, which has been proven to improve the quality of care provided to that patient. As healthcare transitions from a fee-for-service to a value-based care model, the PCMH structure has been shown, in most cases, to provide quality patient outcomes, and is particularly beneficial for patients who require coordinated care.

Nick Dealtry
August 8, 2017

Read

Demand for primary care physicians up but pay disparity remains

The demand for primary care physicians continues to rise. In the midst of an increasing general industry shortage of all physicians, the American population is aging and will need more primary care physicians to coordinate their healthcare needs in the coming years. The result is a demand that is not being met, with some regions critically underserved. Even with that demand, the pay for primary care remains consistently lower than for specialty providers. Modern Healthcare's 24th annual Physician Compensation Survey found that the median income for specialty physicians in 2016 ranked consistently at the top of the pay range: Orthopedic surgeon, the highest among 23 medical specialties: $579,000 Invasive cardiologists: $575,810 Radiation oncologists: $515,999 Gastroenterologists: $495,300 Radiologists: $477,390 In contrast, the median income for a pediatrician in 2016 was $228,530. Modern Healthcare reports that “Primary-care specialties such as internal medicine, family medicine, emergency medicine, pediatrics, hospitalist care and obstetrics and gynecology all remained at the bottom end of the physician pay scale despite most seeing steady rises in compensation from 2015 to 2016.” The demand for primary care physicians has been spurred on, in part, by a move toward value-based care in the healthcare field. Healthcare facilities such as hospitals are also now more focused on population health management, increasing the need for primary care providers to work with patients on quality health outcomes. Focusing on the quality of care instead of the quantity of visits encourages primary care physicians to spend more time with each patient. While the patient benefits tremendously from the new value-based focus, and patient engagement improves significantly, it also means that more primary care physicians are needed for the care of those patients. Improving the pay disparity between primary care physicians and specialty physicians will help alleviate the shortage. The new performance-based reimbursement structure under the Medicare Access and CHIP Reauthorization Act (MACRA) may also impact the compensation structure. Other remedies might include student loan forgiveness or assistance for those choosing to go into primary care. Here at Elation, were committed to ensuring independent primary care physicians have all the tools they need to provide the level of care they are known for. As value-based care potentially disrupts primary care demand and reimbursement - we’re here to support.

Kimmy Hu
August 8, 2017

Read

How team-based primary care models can improve patient care outcomes

A recent study published in the Canadian Medical Association Journal came to the conclusion that team-based primary care models lead to better patient outcomes. Researchers at McGill University in Montreal studied data involving 620,000 admissions, including more than 312,000 older or chronically ill patients that were admitted to hospitals between November 2002 and January 2009 and were enrolled in team-based or traditional primary care practices. According to the study, team-based primary care models did not significantly affect 90-day readmission rates, but patients enrolled in those practices had lower 30-day rates of emergency department visits not associated with readmission and a lower 30-day mortality. This study reiterates how important the value of care coordination is, especially to chronically ill and older age patients. Still, there is a lack of care coordination for most patients, which can be due to doctors receiving conflicting information or not having timely access to a patient’s medical history, among many other issues. When practices use the expertise of a variety of provider team members, their patients are more likely to get the care they need. A larger provider team can also support quality improvement with effective intra-team communication and problem-solving. However, sometimes that is not enough, to truly create improvements in care quality physicians need the tools to communicate without restrictions. How a Clinical EHR can help Elation understands the frustration and the necessity for better tools for physicians to use to improve care coordination. We envision to enable physicians to connect and share patient information while putting the patient’s data at the center of every interaction. We’ve introduced these ideas into tangible parts of our Clinical EHR. Features ranging from electronic faxing and letters to DIRECT Messaging, the Elation Provider Network, and the Collaborative Health Record which all contribute to improving care coordination head-on. Using a technology platform that deeply respects the doctor-patient relationship and how important it is, can play a significant role in not only improving care coordination but also strengthening this relationship. Contact us to learn more about how a Clinical EHR can help.

Nick Dealtry
August 3, 2017

Read

Primary care physicians’ role in reversing cardiovascular disease

Cardiovascular disease (CVD) includes a number of disorders, as defined by the World Health Organization (WHO). Hypertension, heart attack, stroke, and congenital heart disease are among those disorders listed in the CVD group. WHO also states that cardiovascular disease is the world’s number one killer. An estimated 17.5 million people worldwide die from CVD, about 31% of all deaths worldwide. How can independent primary care physicians take an active role in reversing cardiovascular disease in their patients? Attacking the disease at its root cause may actually be the most effective way to combat CVD.  In fact, the American Heart Association recommends that patients “Get regular medical care from your primary care physician. Even though you have a cardiologist, you still need a primary care doctor who is in charge of all your medical care.” An independent primary care physician who is able to see the complete medical profile of the patient and then is able to collaborate with specialty providers and healthcare facilities may be most effective in addressing the root causes of cardiovascular disease. WHO identifies several key messages to protect heart health that can be relayed to the patient in the primary care physician’s care: tobacco use, engaging in physical activity for at least 30 minutes every day, and eating at least five servings of fruit and vegetables a day. Patient engagement encourages the patient to take an active role in his or her heart disease prevention plan as well. A patient who is able to communicate directly with the primary care physician has automatic access to critical health information, and will be able to see test results, ask questions, and receive treatment plan updates. Primary care physicians play a significant role in encouraging healthy habits among their patients, and that may well reverse the often devastating effects of cardiovascular disease.

Kimmy Hu
July 31, 2017

Read

Primary care and mental health

The primary care physician has typically been viewed as someone who sees patients for preventive care, diagnosis, and referrals to specialty providers, all related to physical issues. However, with a growing shortage of psychiatrists and an increase in costs for patients, it is becoming more common for a primary care provider to treat patients for mental health concerns as well. Primary care providers can provide mental health services on a relatively basic level, diagnosing and treating a patient for conditions such as depression or anxiety. Most often, the treatment consists of medication prescriptions but should also include collaborative care, coordinated for more enhanced treatment by a mental health professional. The National Institute of Mental Health (NIMH) states that “Collaborative Care has been found to improve quality of care, satisfaction with care, and both mental and physical health outcomes.” Unfortunately, primary care providers have not traditionally been paid for additional collaborative care efforts. Effective January 1, 2017, however, Medicare began reimbursing providers who collaborate care with mental health providers for those patients with mental or behavioral concerns. The hope is that private insurance companies will follow suit. NIMH also states that, as of December 2016, “it is believed that only about 10% of patients with depression receive appropriate mental health care when visiting their primary health care provider.” Communication with a patient’s specialty providers, including their mental health provider, is a crucial component of quality coordinated care. The patient’s physical medical history can impact mental and behavioral health treatment and vice versa. A patient with depression, anxiety, or addiction issues may be more willing or better able to visit a primary care provider for basic mental health treatment. The primary care provider can then manage that patient’s care, ensuring that a referral to a mental health professional includes information about the patient’s physical health, through shared electronic health records (EHRs), for example. Collaborative care, coordinated between the primary care physician and the mental health provider, helps patients access the care they need and improves patient outcomes.

Nick Dealtry
July 26, 2017

Read

What do primary care physicians need to know about precision medicine?

The primary idea behind precision medicine is that every patient is different, with different genetic makeups and living in different environments that may affect how effective a particular treatment will be for each person. Precision medicine hones in on the specific genes and environment to determine which medication and dosage level, for example, will work best for managing each person’s disease or condition. The calculation is more precise and dependent on more factors than the traditional measures of age and weight used to determine dosage. Precision medicine has typically been used when treating an existing condition. Dr. Megan Mahoney, Chief of General Primary Care at Stanford University’s division of Primary Care and Population Health, wants to see precision medicine move “upstream,” to the primary care provider’s office, to help in preventative treatments. Making a change in today’s healthcare crisis, as Dr. Mahoney sees it, would entail a more team-based approach on the part of the primary care physician. Adding staff to the primary care practice will be important as precision medicine moves to preventative care. The physicians can then “practice at the top of their license, focusing on assessment, diagnosis and treatment rather than administrative tasks.” Stanford University plans to “begin a yearlong pilot with 50 to 100 patients from demographically and socioeconomically diverse backgrounds, and will identify ways to reach them to offer preventive care and engagement opportunities based on electronic health records dashboards.” The project team will then identify those patients who may benefit from a precision medicine approach to their preventative care in the primary care provider’s office. The precision medicine approach may also help primary care physicians increase their patient engagement, as they get to know each patient a little better. Taking advantage of technology that enables them to access medical records and visit notes quickly will enable the primary care physician to spend more time with the patient. Understanding the patient’s complete profile can enable the primary care physician to be more effective with the quality of preventative care.

Greg Miller
July 26, 2017

Read

Efficiency tips for independent primary care practices

Everyday inefficiencies plague healthcare - particularly primary care. Big pictures changes cannot happen overnight but that doesn’t mean there aren’t any smaller scale solutions. If you find your practice struggling, here are a couple of strategies that independent primary care physicians can use to make their practices run more efficiently. Creating the “A Team” By training “a teams” consisted of a diverse set of health professionals from physician assistants to therapists, this team has then extended physician capacity. “There are a lot of routine needs that don’t necessarily require a physician,” says Edward Salsberg, MPH, a research instructor at The George Washington School of Nursing. Incorporating health professionals like nutritionists, occupational therapists and social workers into the teams can improve a patient’s health and ability to function while allowing a more efficient delivery of preventive care that helps keep patients healthy and away from the hospital. Using technology to your advantage Investing in an EHR system for independent primary care physicians can give your practice complete flexibility in how you deliver care, help you automate data entry to maintain a more comprehensive and longitudinal patient record and help you drive phenomenal patient outcomes. This technology can aid you in focusing more on your patients than on your screen. Coordinate care efficiently and automatically share updates directly from your Clinical EHR to other providers so they can take action based on the most up-to-date clinical information. Taking this step further to investing in an Interoperable EHR system; meaning that the electronic sharing of patient information between different EHR systems and healthcare providers can happen. Get help for your admin duties According to PwC Health Research, a major source of inefficiency in primary care practices is that physicians have to spend more than a third of their time and significant resources on administration duties. Using an EHR system that is integrated with a practice management software can save your practice time when doing the necessary administrative duties, leaving you with less screen time and more patient facing time. Elation Health’s Clinical First EHR can help you efficiently manage the operations behind your practice and reduce the burden of day-to-day administrative tasks by easily managing appointments, check-ins, and copays; sending and receiving electronic faxes, and tracking your practice’s performance, clinical quality measures, and meaningful use criteria measures all in one place.

Kimmy Hu
July 26, 2017

Read

What is community-oriented primary care (COPC)?

Community-oriented primary care (COPC) is a process of improving a community's health by using principles of public health, epidemiology, preventive medicine and primary care that has been shown to have positive health benefits for communities in the United States and worldwide. In 1999 the American Public Health Association gave the following description of COPC: “Community-Oriented Primary Care (COPC) is a systematic process for identifying and addressing the health problems of a defined population. It can be implemented with the resources available in most communities. In COPC, a team of health professionals and community members work in partnership over a long period, diagnosing and treating a community in much the same way as does a primary care physician with an individual patient. Primary care practitioners are not required in every project, and they are usually too busy to lead such an effort, but they must be involved.” Importance of primary care providers COPC offers the possibility of addressing the environmental and social causes of bad health within a community, with the assistance of a primary care physician. The steps that are taken within COPC to diagnose and treat communities follows the same foundations that of a primary care physician. Primary care providers are the “quarterback” of a patient’s healthcare experience, they coordinate care with all of the patient’s specialty physicians in order to keep everyone up-to-date the patient’s health, make sure they have the right tests done without duplicates, among many other responsibilities. The main objective of COPC is heavily based around the functions of primary care physicians. In the transition to value-based physician payment models, community-oriented primary care (COPC) is attracting interest as a care model focused on improving health outcomes on a population level. Click here to learn more about how Elation Health’s Clinical EHR supports innovative care models.

Greg Miller
July 21, 2017

Read

The impact of annual wellness checks

Primary care physicians have long emphasized the need for preventive health. Annual wellness checks, or physicals, have been an intrinsic part of the preventive plan for their patients. Most private insurers cover the cost of an annual exam and even Medicare has recently begun paying in full for an annual wellness check for recipients. Some experts, though, believe that the annual wellness check is not necessary, particularly among younger patient populations. Writing in the Harvard Health Blog, Amy Ship, MD, points out that “these annual visits don’t make any difference in health outcomes,” according to a number of large studies. She further explains that an annual wellness check does not necessarily keep a patient from getting sick or even help the patient live longer. However, she also cites the fact that “many doctors and patients perceive the annual visit as a critical opportunity to cement the doctor-patient relationship and a way to ensure that people receive appropriate screenings and preventive care.” That patient-physician relationship can be crucial in impacting the level of care provided during each visit. When a patient feels that the physician is truly listening and has a vested interest in the patient’s well-being, the patient becomes more engaged as well. Ship’s article proposes a separate visit to establish that relationship, rather than relying on the annual wellness check to make that happen. Follow-up communication is another significant element in developing that patient-physician relationship, in addition to having an impact on the quality of care a patient receives throughout the year. The Harvard Health article also suggests that primary care physicians “will need to find a more proactive way to monitor their patients’ attention to preventive care” if the annual physical exam is eliminated. An EHR tool, such as Elation’s Clinical First EHR, enables the primary care physician to quickly identify patients who aren’t meeting goals based on custom care management protocols, Meaningful Use objectives, or specific document tags, and easily schedule a follow-up appointment to address any potential gaps in care.

Kimmy Hu
July 18, 2017

Read

How investing in primary care can help us reach the triple aim

Only 6–8% of healthcare dollars are spent on primary care services even though primary care has been shown to help achieve the “triple aim” of improving care and health while reducing costs. The “Triple Aim” includes improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations. The Center for Medicare and Medicaid Innovation’s (CMMI) Comprehensive Primary Care (CPC) initiative and Rhode Island’s statewide payment innovation model provides evidence that additional investment in primary care is expected to assist transformation, improve patient outcomes, and will be cost neutral, or cost saving, overall. Since the start of the CPC initiative in 2011, $371 million was spent in per-member-per-month fees and the amount spent on primary care for the most complex patients doubled. The primary care investment in Rhode Island expanded almost by 40% between the years of 2008 and 2012, where they were mostly investing in medical home transformation. To create new and innovative models for primary care, in order to help the clinical first primary care providers and the healthcare system as a whole; there needs to be fundamental and structural alterations. The CPC initiative states five advances that will improve primary care delivery but that will require investment: 1) improved access and continuity; 2) planned care for chronic conditions, preventive care for high-risk patients, and team-based integration of behavioral health; 3) risk-stratified care management; 4) patient and caregiver engagement, and; 5) coordination of care across the medical neighborhood. All of these advances require all types of health systems to invest vital resources into their primary care framework. Blue Cross and Blue Shield of Rhode Island administered a study with over 100,000 members, these members being practices that had sustained patient-centered medical home transformation. The transformation was done through the CTC and over a 5 year time span this study showed a 5% cut in costs and a savings of $30 million, with comparing this to other primary care practices. Using this model can bring improved patient access and improved care coordination and management as well as avoiding unnecessary hospital admissions. The savings on cost that was presented in this model shows a 250% return on investment in transforming practices into patient-centered medical homes, this being done by having 16% less hospital admissions and 30% less readmissions, compared to other primary care practices. The research from Rhode Island provides evidence that investing in the primary care delivery system can pay off by improving outcomes such as hospital use over time. Federal investments in medical home transformations are following Rhode Island’s footsteps and are mostly being made through increased fee-for-service payments, per-member-per-month fees and a shared savings in ACO models or pay-for-performance quality incentives. Only a few have invested at the same levels as the CPC initiative or in the same CTC practices that were used in Rhode Island. Most of the time payment systems don’t come close to matching the increase in resources that is needed to make an essential investment into primary care. The average 0.5% decrease in spending due to using shared-savings models isn’t enough to to support the base that is needed to transform practices and continue care management. A new payment system needs to be created that will enable primary care to serve as the capable and valued base of a high-functioning health system. The CPC initiative is too constrained by the limits of its investment and its dependance on the fee-for-service payment. The Rhode Island model can give the correct amount of resources needed but can be strained by the use of fee-for-service as the foundational payment structure. As of now, track two of the Comprehensive Primary Care Plus (CPC+) action is offering the decreased fee-for-service payments in exchange for larger payments paid quarterly that will make up for the loss of the fee-for-service revenue, which can have the effect of pushing practices closer to cost. With a dedicated and thorough investment in primary care and the assessment of it, only then will we be able to save our healthcare system and realize how much promise is in the primary care system. [alexraths] © 123RF.com

Kimmy Hu
July 17, 2017

Read

MIPS v. APMs

There are two different tracks for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The first, the Quality Payment Program consolidates current fee-for-service Medicare programs (Meaningful Use, Physician Quality Reporting System, and Value-Based Payment Modifier) into a single program called MIPS – Merit-based Incentive Payment System. The second is applied to clinicians who are exempt from participating in MIPS because they are a qualified participant in an APM, which is called the Advanced Alternative Payment Models (APMs). MIPS: MIPS is a performance-based payment system composed of four categories that provide clinicians the flexibility to choose the activities and measures that are most meaningful to their practice. An eligible clinician’s performance in each of the four weighted performance categories is combined to create the MIPS Composite Performance Score, also known as the MIPS Final Score, which is used to determine Medicare Part B payment adjustments in future years. The four performance categories for MIPS are: Quality (measurements like PQRS) Practice Improvement (transforming operational process) Advancing Care Information (rebrand of Meaningful Use) Resource Use or Cost (The Final Rule removed the Resource Use requirement for this year but it will be increased in the following years) Each category is weighted as follows: Quality 60%, Practice Improvement 15%, Advancing Care Information 25%, Resource Use 10% Based on the MIPS Composite Performance Score, physicians will receive +/- or neutral adjustments up to the following percentages: 2019: -4% to 4% 2020: -5% to 5% 2021: -7% to 7% 2022+: -9% to 9% APMs: The Advanced APM path is for providers who take on added risks when treating their patients while delivering high-quality, coordinated, and efficient care. To be an Advanced APM the three criteria must be met: Require participants to use certified electronic health record technology Provide payment for covered professional services based on quality measures similar to those used in the quality performance category of the Merit-based Incentive Payment System (MIPS) and Either: (1) be a Medical Home Model expanded under CMS Innovation Center authority; or (2) require participating APM Entities to bear more than a nominal amount of financial risk for monetary losses. Once physicians are participating in an Advanced APM, they can earn the 5% incentive payment in 2019 for Advanced APM participation in 2017 if: - Physicians receive 25% of their Medicare Part B payments through an Advanced APM or - See 20% of their Medicare patients through an Advanced APM In order to meet Advanced APM Qualifying Participation requirements, you’ll also need to send in the quality data required by your Advanced APM. If a physician decided to leave the Advanced APM in 2017 they should try to meet the Advanced APM requirements for that year to receive the 5% bonus. If they cannot meet these requirements they will need to submit data to be a part of the MIPS program, otherwise, they will be subject to the -4% payment adjustment in 2019. The simple difference between MIPS and APMs is the amount of risk physicians are willing to take on and the amount of the payment adjustment (being positive or negative) they receive for trying to transition to a value-based care model. While participating in an APM you are taking on more risk as a physician or practice and for that you are rewarded with a 5% bonus if you meet those requirements, while being enrolled in MIPS you need to submit your data demonstrating your performance in the transition to value-based care, your reporting data is then scored; a higher score indicates earning payment incentives and a lower or no score indicates a paying a penalty. These tracks are both better suited for larger practices and organizations because they will have more resources to make sure that they can keep up with the requirements for both MIPS and Advanced APMs. However, some independent primary care physicians may be exempt if it’s their first year excepting Medicare payments or if they bill less than $30,000 in Medicare per year or see fewer than 100 Medicare patients. As of 2017, virtual groups (which allow physicians of small or solo practices to pull their resources together so they can participate in the QPP) will not be implemented but CMS is planning on implementing the groups in 2018.

Nick Dealtry
July 17, 2017

Read

89% of patients value their relationships with primary care physicians

Access to a primary care physician for patient care has been shown to be effective in improving patient outcomes. Also important to the patient, according to 89% of those polled in a recent survey, is the relationship the patient has with that primary care physician. The survey, conducted by Health is Primary, a campaign from Family Medicine for America’s Health (FMAHealth), asked a national sample of about 22,800 registered voters about a number of aspects of their healthcare. Additional results from the survey include: 88% said it's important to ensure coverage for preventive and wellness care to keep patients healthy 91% said it's important that healthcare is affordable 85% said physicians should be paid based on the value of the care they provide and not on the number of procedures they perform 88% said it should be a priority of the country to ensure access to family and primary care physicians A relationship with a primary care provider is important to patients. Fierce Healthcare reports, however, that a government survey conducted in early 2017 showed that there are still a number of Americans who do not have a primary care physician at all. In fact, the report states that “28% of men and 17% of women don’t have a personal doctor or healthcare provider.” Access to healthcare, particularly to a primary care provider, can make a difference in the quality of a patient’s coordinated care and overall health, particularly for chronically ill patients. At Elation, we believe that the primary care physician can play a significant role in a patient’s healthcare outcomes. We also believe that a positive relationship with a primary care physician includes the ability to communicate directly with the physician. Patients quite often have important questions after their visit and need an advanced technology tool that enables them to get answers securely and seamlessly. Elation Health’s philosophy has always been and will continue to be focused on strengthening the relationship between patients and physicians, and enabling phenomenal care for everyone.

Kimmy Hu
July 11, 2017

Read

Primary care compensation goes up according to new report

The healthcare environment is changing, with reimbursement transitioning from fee-for-service to value-based payments. At the same time, healthcare insurance options are in flux, with the Affordable Care Act (ACA) potentially being replaced by a new healthcare law. The value of the primary care physician, however, continues to be paramount in the overall patient health care picture. That value is reflected in the increasing primary care physician’s compensation over the past several years. A 2017 Merritt Hawkins survey and the subsequent report reveals that the average family medicine physician income has increased significantly since the 2012/13 survey year: 2016/17             $231,000 2015/16             $225,000 2014/15             $198,000 2013/14             $199,000 2012/13             $185,000 The 2017 Review of Physician and Advanced Practitioner Recruiting Incentives emphasizes that, even with the current healthcare regulatory environment and with the growing importance of various types of specialty healthcare providers, physicians “continue to be the indispensable caregivers at the heart of the healthcare system.” The Review points out that physicians: Handle over 1.2 billion patient visits a year, in offices, emergency departments and other settings. Control 87% of all personal spending on health care through hospital admissions, test orders, prescriptions, procedures, treatment plans and related activities. Generate $1.6 trillion in economic output collectively. Account for $2.2 million in economic output individually. Support 14 jobs each. Elation Health focuses on helping primary care physicians continue to be effective in providing quality healthcare to their patients and continue to run a financially healthy practice. A significant aspect of the overall financial situation for an independent primary care physician is effective practice management. Elation has always been focused on building a technology platform that physicians actually want to use, that improves patient outcomes, and that will eventually transform the delivery of healthcare itself. Our Clinical First EHR provides all of this and more, so the primary care physician can continue to provide the highest quality healthcare available in a cost-efficient setting. Learn more about how Elation supports independent primary care physicians.

Greg Miller
July 10, 2017

Read

What are virtual groups and how can primary care physicians benefit from them?

In an effort to reduce the reporting burden on small and independent primary care practices participating in the Quality Payment Program (QPP) as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Centers for Medicare & Medicaid Services (CMS) has issued a proposed ruling that outlines a number of changes for 2018. One of the most significant aspects of the proposed change is a concept called “virtual groups.” For primary care physicians, the new ruling should alleviate much of the administrative burden of complying with program requirements. With the new proposed rule, says CMS Administrator Seema Verma, the aim is to “improve Medicare by helping doctors and clinicians concentrate on caring for their patients rather than filling out paperwork.” Virtual groups will be comprised of 10 or fewer eligible physicians, who join together virtually to participate in the Merit-based Incentive Payment System (MIPS) in 2018. Virtual groups ease the burdens on primary care physicians as they will be able to pool their resources and report together. Elation plans to offer functionality to these providers that allows them to dynamically collaborate on patient charts – a key driver of success in the new MACRA reimbursement system. Elation believes that virtual groups can and should be a powerful tool to not only create administrative efficiencies for participating providers, but also to clinically benefit patients and to encourage collaboration that improves the quality of their health care. Independent physicians are already focused on the quality of care they provide to their patients and generally are adept at coordination of services. Virtual group participation should improve the quality of care received by patients of the participating providers by facilitating care coordination and improvement activities. CMS states that “The Quality Payment Program, updated annually as part of MACRA, is meant to promote greater value within the healthcare system.” The new proposed ruling on virtual groups will enable primary care physicians to more actively participate in this program and to continue to contribute to higher quality healthcare delivery.

Nick Dealtry
July 6, 2017

Read

Survey reveals national attitudes toward primary care

Independent primary care physicians work hard and face many challenges. The primary care physician focuses on overall patient health, while collaborating with specialty providers and healthcare facilities. Of course, improved patient outcomes are reward enough, but independent primary care physicians may also be wondering, what do Americans think about the state of primary care now? A survey was conducted recently of 22,800 registered voters to determine their attitudes toward primary care. The survey was part of the Health is Primary campaign, out of Family Medicine for America's Health (FMAHealth) which was created in 2013 by the American Academy of Family Physicians (AAFP). The survey participants overwhelmingly agreed that “primary care should be a priority for policy makers.” In addition, 86% of the survey participants stated that “primary care leads to: healthier patients, higher quality health care, and lower costs.” 88% of Americans responding to the survey said it is important to “ensure coverage for preventive and wellness care to keep patients healthy” and an equal number said it is important to “ensure an adequate supply of primary care doctors.” Among the priorities for their own health included in the survey, the highest percentage of respondents, 89%, said “it’s important to have a relationship with a doctor or physician who knows your health background and your family and medical history.” Independent primary care physicians who communicate regularly with their patients are able to develop that relationship that then enables them to provide quality healthcare. In addition, an EHR system that provides all of the patient’s health information in one place, available with one touch, assists the primary care physicians in gathering an overall picture of their patients’ background and medical history. At Elation, we are focused on supporting that physician-patient relationship that has been identified as an important factor in the national attitudes toward primary care.

Kimmy Hu
June 21, 2017

Read

Why primary care doctors are trailblazers for Value-Based Care

As healthcare transitions from fee-for-service to value-based reimbursement, primary care physicians are the most well-equipped physicians to lead the transition and have the most to potentially gain from the transition as well. With the cost of healthcare services continuing to rise, patients will start demanding more and more value, while also asking for more transparency and for tools to evaluate if they are receiving the appropriate value of care for what they are paying. Value-based care suggests that we might be able to considerably improve the quality of care provided to patients while reducing the total cost of care. For this to happen we need to enable primary care physicians with the tools, technology, procedures and economic incentives to help them transform the healthcare system. The California regulatory model for fully capitated primary care delivery strongly believes in partnering with independent primary care physicians so that we can provide integrated support, technical systems and framework, and a knowledge of reporting requirements in order to help small practices survive and eventually succeed in the transition to value-based care. If we had this type of support system for physicians transitioning to the value-based care models there would be much less resistance to the change. As stated by the American Academy of Family Physicians, one in three family physicians is already actively pursuing value-based payment models. Primary care physicians goals align with this type of patient care and reimbursement framework, however, physicians have stated that the lack of time and resources to implement the change as being one of the largest difficulties involved in value-based care. Finding new ways to help physicians manage their costs of care, allow for a greater work-life balance and improve the level of care they give to their patients, can be a very valuable service during this time of transition. To learn more about Elation Health’s cloud-based Clinical First EHR solutions and how we can help you succeed in the new value-based care landscape, contact us today!

Nick Dealtry
June 15, 2017

Read