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Thursday Jan 09, 2014

Banding Together Helps Small Practices Achieve PCMH Recognition

Editor's note: During the AAFP's Scientific Assembly in San Diego, a panel discussion on practice transformation generated far more questions than the panelists could answer in the time allotted. This is the third post in an occasional series that will attempt to address the issues members raised -- including the challenges associated with transforming a small practice -- during the panel.

When the topic of practice transformation comes up, one of the most frequent questions we hear is, "What about the little guy?" How are small practices expected to overcome the additional work and expense needed to achieve patient-centered medical home (PCMH) recognition?

This is a valid question, but the answer might be simpler than you think. For my small practice, the solution was to find strength in numbers. And that didn't require anything as complex as joining an accountable care organization or an independent practice association.

There's a common belief in health care that large group practices are more viable during practice transformation. My practice, however, has just two physicians: me and my wife (who is pictured with me here). We think the medical home model is the future of medicine, but we want to remain independent. So, 18 months ago, we sat in a meeting with other small practice owners from in and around San Antonio who also were interested in achieving PCMH recognition.

We realized that if our small practices worked together, we would have the resources of a large group practice. For example, if one practice researched what was needed to meet a specific PCMH requirement and developed a strategy to achieve it, that practice could then share its results with the other nine practices.

Economy of scale is essential. Having several small practices working together made us much more likely to succeed. Looking for community partners that support the medical home is another move that improved our chances for success. In our situation, those partners include a large health system and a local payer.

With a newfound network of support, we divided the numerous challenges amongst the practices and went to work.

After reviewing the PCMH checklist, my wife and I realized our practice already was meeting three-fourths of the requirements. National Committee for Quality Assurance (NCQA) Level 1 recognition was relatively easy for us to achieve, and all 10 practices achieved it at roughly the same time.

Of course, we had room for improvement. Our practice improved access by implementing open-access scheduling and a patient portal.

Building a staff where everyone buys in to the effort also is critical. Our staff performance has improved through the process. Labs are completed on schedule, we have fewer overlooked test results and we do a better job of ensuring that immunizations are up to date.

NCQA Level 2 recognition was about three times more challenging than Level 1, but within a year of starting this process, we were there. Not all 10 practices reached that milestone at the same time, but all 10 have made it. Five of the practices, including ours, are now working on reaching Level 3, which is a daunting task. Once the first five practices reach Level 3, we'll help the other five do so as well.

So what is the future for small practices? Systems will adapt to allow us to survive. We are too important not to, especially in underserved areas. Still, we have to be willing to listen to options, and sometimes you have to be creative.

Local hospitals have an interest in our survival, and so do payers who want to reduce costs through better care. Our group has asked for help from both. For example, the Christus Santa Rosa Health System has been supportive of our efforts, including by providing space for our meetings. The system has bought into the importance of primary care and the vision of primary care as the foundation and future of health care.

In addition, our project has been partially funded by Blue Cross and Blue Shield, which has provided a case manager to work with our practices. The payer also has pledged to provide a 5 percent payment differential for practices in our group that achieve Level 3 recognition. That 5 percent bump will help us pay the case manager after the project is completed.

Being a small practice doesn't necessarily mean having limited resources. Sometimes you have to look for -- or build -- your own system of support. We're a small, rural practice, but Level 3 is within our grasp.

In the next few weeks, the AAFP will be introducing a new tool that provides step-by-step work plans to guide practices through PCMH transformation. Learn more about this new resource, the PCMH Planner, here.

Lloyd Van Winkle, M.D, is a member of the AAFP Board of Directors.

Comments:

Small practices are going to see a rebirth as they are often a more efficient means to reach the Triple Aim than many centralized, consolidated models. A healthy inter-dependence can be far more rewarding than independence.

Posted by Randall Oates, M.D. FAAFP, NCQA PCMH CCE on January 11, 2014 at 12:44 PM CST #

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