Practice Transformation, Health Information Technology, Payment Reform: Is There Optimism for Primary Care?
I recently celebrated 21 years as an independent family practitioner in Grand Junction, CO. Frustrated and exhausted from trying to maintain my income and practice in the face of ever-increasing overhead expenses, I was not expecting to celebrate many more years at my job. That was until we began our journey with health information technology (health IT).
It started five years ago when our community came together to fund and deploy a health information exchange called Quality Health Network in Mesa County. This technology gives us the capability to receive much of our clinical data from labs and hospitals in an electronic format. It also populates a community-wide health information database, which we can access to get additional clinical information about our patients that we may not have in our own medical records.
Our practice decided to "take the plunge" and purchase an electronic health record (EHR) system three years ago. At that time, EHR vendors were advertising that their tool allowed for more complete documentation of patient encounters, which meant visits could be billed at a higher level of service. They also said that this technology would pay for itself over the course of a few years. Unfortunately, the discussion about EHRs centered on the documentation of care, not how to use the technology to improve the quality of care.
With the passage of the American Recovery and Reinvestment Act, the Federal Government committed billions of dollars to encourage the spread of health IT. The goal is to use health IT in a meaningful way to improve the quality of care and reduce the increasing rate of health care expenditures in this country. The key word here is “meaningful." As our practice discovered, simply having an EHR for documenting patient visits does very little for improving the quality of care and nothing to help reduce the cost of care. EHRs offer the opportunity to do much more, and the Beacon Community Program is helping my practice, and many others, realize what can be achieved through the meaningful use of health IT.
Last year, our community was one of 17 in this country to receive a Beacon Community Cooperative Agreement Program grant from the U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology. The Beacon Community Program supports communities like ours to build and strengthen their health IT infrastructure and exchange capabilities. We have committed to use this funding to improve the delivery of health care in our region by employing health information technology tools and practicing redesign methods in primary care offices. More than 70 different primary care practices will be involved in the program with a potential impact on more than 300,000 patients in our region.
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As one of the physician leaders for this program, I view this as an opportunity to save primary care, not simply a way to proliferate health information among physicians. Numerous studies have validated the value that primary care physicians bring to our health care delivery system. Yet, fewer and fewer medical school graduates are choosing primary care. The reasons are numerous. Simply funding more residency positions or providing more loan repayment opportunities for primary care physicians will not solve the problem. What must happen is a transformation of the delivery of primary care services so that primary care physicians see more “meaningfulness” in their daily work at the front lines of health care delivery.
This is the one of the goals of the Colorado Beacon Consortium. Using practice transformation coaches, we are learning about work flow, practice redesign, Plan-Do-Study-Act (PDSA) cycles, population management using registry tools, and team-based care. We are collecting data and will be measuring outcomes. We are coming together with other practices in "learning collaboratives” to share best practices on how we are using our technology to work smarter, not harder. I notice a renewed sense of excitement within these practices as we work together to redesign the delivery of primary health care services.
Lastly, but most importantly, we recognize the importance of testing new payment methods for primary care services as part of the Beacon Community Program. The fee-for-service system of payment has been the most significant factor in demoralizing and devaluing primary care in this country. Without payment reform, we cannot sustain a transformed, high-quality, efficient primary care delivery system. Using the funding we received through the Beacon Community Program, we are hoping to demonstrate how costs can be reduced and patient care improved through the collection, analysis, and sharing of clinical data, and the redesign of primary care practices and clinics.
The Beacon Community Program has given me a glimmer of hope that my final decade of medicine will be "meaningful" for myself and my specialty: primary care.
Gregory C. Reicks, DO, FAAFP, is President of the Mesa County Physician's Independent Practice Association and is part of the Colorado Beacon Consortium's executive leadership. Dr. Reicks is also the Chairman of the Quality Health Network and a practicing clinician at Foresight Family Physicians, PC, in Grand Junction, CO.