IMPs, in my opinion, seem to be the most
nimble at adopting these necessary changes, and not the mega-practices down the
street. I think we can and do implement these changes faster and better,
because of our small size (fewer people to convince). I doubt the large
practices (>2 providers) will really embrace these changes until the
almighty dollar convinces them to (reimbursement restructuring).
Michelle A. Eads, M.D.
Pinnacle Family Medicine, PLLC
(719) 687-8752 phone (719) 687-8753 fax
From: IMPcohort2@yahoogroups.com
[mailto:IMPcohort2@yahoogroups.com] On Behalf Of L. Gordon Moore
Sent: Friday, September 08, 2006 8:35 AM
To: IMPcohort2@yahoogroups.com
Subject: [IMPcohort2] NEJM thoughts and the campaign for confidence
I
think Michelle Eads is right on target. Not having to convince others is
the reason I chose to reform my practice as a solo enterprise. I was
unable to convince my colleagues to take the journey I had envisioned.
This coincides with John Wasson's articles and experience: when you can control
your work environment, you can make effective change.
The changes we are making in pursuit of patient-centered collaborative care are
significant. The biggest changes are in our philosophical approach to
working with patients. If we can cross that chasm, we can expect
significant and lasting improvements in patient outcome. For each of us
on this journey the question becomes "Where do I need to
change?" The answer to that is in the HYH data.
How do your patients rate their:
access
efficiency
continuity
very good information
confidence
While IMPs are some of the best practices in the country, we still have room
for improvement.
One shining example of 90% and better self-confidence is the CareSouth experience in helping people
manage HTN. The key to that success was in the explicit targeting
of confidence. For IMP1s, it is for that reason we pursue a confidence
campaign as an explicit goal, using the Confidence Coach document
and Telecoach as tools to assist our work.
For IMP2, it starts with asking the question. The means to ask are
integral to HYH and in CARE vital signs, hence the need to get going with use
of the tool.
Gordon
I left a 150 doctor group 2 years ago for solo practice largely to seize control of practice management and overhead expenses. Best thing I ever did in 27 years of practice. I am doing a better job and have improved the bottom line. I still prefer however to see 100 patients per week (in 4 days).
Also- the first patient to complete HYH was seen today. I picked up the fact that he’d never received pneumovax and directly addressed his confidence in managing his own condition. Interestingly his lack of confidence seemed to relate largely to the fact that he has an implanted defibrillator made by a company that has had a number of recalls. His cardiologist kept blowing him off about this topic. I pulled out an appropriate article and noted the relatively small absolute risk reduction from the device in his circumstances. I also used the manufacturer’s website to reassure him that his model had not been recalled. He left much more confident.
I don’t think the visit would have gone the same way without HYH. So thus far I am 1 for 1.
Rodney Hornbake MD FACP
10 Wildwood Medical Center
860-767-0145