“The landscape of American health care is changing. Payment will be tied to value, and value means quality. If we as family docs don’t talk about what we do in a convincing way, we aren’t going to get anywhere,” Dr. Richard Streiffer, dean of The University of Alabama College of Community Health Sciences, said at the opening session of the annual meeting of the Alabama Academy of Family Physicians held in June in San Destin, Fla.
CCHS faculty were speakers at many of the session held at the annual meeting.
The opening session was titled the “Principles and Benefits of Practice Transformation and the Patient-Centered Medical Home Model.” In addition to Streiffer, speakers included: Dr. Paul Grundy, global director of Healthcare Transformation for IBM; Dr. Reid Blackwelder, board chair of the American Academy of Family Physicians; Dr. Jane Weida, past president of the American Academy of Family Physicians Foundation and associate residency director for the College; Dr. Robert Moon, medical director of Alabama Medicaid; and Dr. Lloyda Williamson, director of the College’s Telehealth Division and an associate professor in the Department of Psychiatry and Behavioral Medicine.
Grundy explained that the patient-centered medical home (PCMH) is a house for data, and with data physicians can manage patients and populations and ultimately improve health outcomes. “Data will make clear what is happening. The future of medicine will be based on data.”
“Doctors were the data repositories, but as data became more complicated we specialized to the point that we couldn’t connect,” Grundy continued. “Those with the most exotic data (specialists) were paid more. Now what’s going to be valued is a doctor who manages a population and guides patients through the healthcare system.”
He said the PCMH will make primary care physicians relevant. “We don’t need episodic care for diabetics; they need to be managed and this is what a PCMH can provide. When we reward the most exotic information, the primary care doctor is not important. But when you’re repositioned from doing small things to managing patients that makes you relevant.”
Blackwelder acknowledged that payment reform could create hurdles for physicians. “We want to be paid for value, but it might require more paperwork.”
Still, he said including primary care physicians so prominently in the discussion about health care reform, “and to be asked for our opinion is huge. But we don’t just need to be at the table. We need to be in the kitchen setting the table.”
Weida, who has guided a practice through the PCMH process, outlined the steps to follow to complete the transformation: decide on the PCMH level to attain; get buy-in from your organization; decide when to certify the practice as a PCMH; know what the standards are (patient-centered access, team-based care, population health management, care management and support, coordination and performance measurement and quality improvement); create a core team that meets regularly; create a support team; keep track of everything; keep everyone informed; and be prepared for backlash.
Williamson spoke about and provided a demonstration of the College’s telehealth activities to show the importance of including technology in the PCMH transformation process “since it can help reduce health-care costs.”
CCHS’s Telehealth Division has provided more than 300 patient consultations to clients of the DeKalb Youth Services Center in Rainsville, Ala.; educated 50 patients and family members through its Diabetes Self-Management Education Program; and provided asthma education to 44 students, parents, teachers and bus drivers at the Ruhama Junior High School in Fort Payne, Ala. These services have been provided in rural areas of the state where access to patient care and patient information is often limited.
“With the limited time physicians have during patient visits, and the limited access many patients, especially those in rural areas, have to health care, we need other resources so that patients can have a better understanding of their disease process and they can have better outcomes,” Williamson said. “Using telemedicine as part of the PCMH adds value to the PCMH model.”
Moon gave an update on Regional Care Organizations (RCOs) in Alabama. RCOs provide for the delivery of medical services to Medicaid beneficiaries on a managed-care basis through regional organizations. RCOs in Alabama will begin providing services on Oct. 1, 2016.
Key features of RCOs are that they are regionally based (there are five regions in Alabama), provider-driven and provide at-risk managed care. “Two-thirds of the Medicaid population in Alabama will be covered by an RCO program. RCOs will look for outliers and provide case management,” Moon said.
He noted that Alabama’s Medicaid program currently covers half of all children in the state, half of deliveries and supports scores of nursing homes and children’s hospitals.
Another session at the AAFP annual meeting focused on unnecessary medical tests and procedures. Streiffer said overutilization of tests is not new, that 53% of physicians order unnecessary tests, but that 85% of physicians are interested in best practices showing that many tests are not needed.
Among the most over-utilized tests in family medicine are EKGs, pap smears for patients under the age of 21, bone scans and tests or imaging for back pain. Reducing the number of tests lowers costs and improves the patient experience, Streiffer said.
Dr. Tom Weida, the College’s chief medical officer, provided a module for physicians to use with a patient suffering from back pain: summarize the exam, elicit patient concerns, show empathy, provide clear recommendations (and a patient handout), avoid imaging and explain the possible harm of MRIs, provide a clear and personalized plan for improvement and confirm the agreement the patient and physician have reached.
Dr. James Robinson, who holds the College’s endowed chair for sports medicine, said while the most common injury in the recreational athlete is knee pain, MRIs are given too often and the need for surgery is rare.
“The reason to do an MRI is if you do need to have surgery. If you don’t need surgery, it will get better. MRIs, diagnostically, are used way too much.”
Instead, patients should be treated with rest, ice, possibly a brace and most definitely hamstring stretching, Robinson said.
The AAFP meeting also included several medical student sessions at which Dr. Richard Friend, director of the College’s Family Medicine Residency spoke. One session focused on “Interview Guidelines for Residency Programs.”
Friend said the residency interview score is often based on the following: commitment to family medicine, ability to work with a program and as part of a team, communication skills including eye contact, professionalism, intellectual ability, work ethic and maturity. He said previous life experiences are important, as is the application’s personal statement. “Spend time with that because it tells us about you; it sets you apart. We want to know why you’re interested in family medicine, that you get it and that it fits you. We want to know that you’re a leader, have discipline, take feedback well and strive for excellence.”
At another session, Friend provided a demonstration for medical students on proper insertion of breathing tubes.