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Changing Culture to Improve Quality and become a Medical Home


Changing Culture to Improve Quality and become a Medical Home Timothy J. McCarren, MD Mark G. Witte, CEO The Family Medical Group Cincinnati,OH – PowerPoint PPT presentation

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Title: Changing Culture to Improve Quality and become a Medical Home

Changing Culture to Improve Quality and become a
Medical Home
  • Timothy J. McCarren, MD
  • Mark G. Witte, CEO
  • The Family Medical Group
  • Cincinnati,OH

Who are we?
The Facts
  • The Family Medical Group
  • 12 physicians largest independent Family
    Practice Group in Greater Cincinnati.
  • 5 mid level providers
  • 3 locations
  • 31,000 patients in our EMR
  • 90 employees
  • Level 3 certification as a patient centered
    Medical home.
  • Top workplaces in Greater Cincinnati, Enquirer
  • Best Doctor Group, CityBeat Magazine

Practice Profile 1/09-12/09
DX Key DX name Total Units Rank
401.1 Hypertension 16717 1
272.4 Hyperlipidemia 10965 2
V04.81 Need Proph VA 10826 3
250.00 DB w/o complications 8628 4
V70.0 PE, Well Adult 6822 5
427.31 Artrial Fib 3853 6
250.02 Diabetes 2 Uncontrolled 2835 7
V06.5 Need Proph VA 2759 8
311 Depressive disorder 2505 9

Ancillary Services offered in the office
  • Cardiovascular
  • Ultrasound
  • Coumadin clinic
  • Echocardiogram
  • Diabetes
  • CDE
  • Retasure
  • Muscular/skeletal
  • Bone Density
  • Physical Therapy
  • MISC
  • Minor surgeries
  • labs

  • Primary Care Innovation Group sponsored by
    Aligning Forces for Quality
  • IBM/CMS Project participated with HealthBridge
  • Preventive Care Initiative with Ohio KePro (Ohio
    Medicares Quality Improvement Initiative)
  • HealthMeasures Public reporting on diabetes
    care in the Greater Cincinnati Region
  • Pilot Practice of the PCMH Initiative in Greater
  • Working with other community stakeholders to
    establish a clinic for the uninsured in a medical
    underserved community in Cincinnati.
  • Patient Advisory Board that meets on a quarterly
  • 5 physicians have leadership roles at the Mercy
    Hospital, Western Hills
  • Dr. McCarren serves on the physician leadership
    group of the AF4Q project.

What does it look like?

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Patient Education
  • Presents
  • Medicare 2011 What you should know
  • How do I sign up?  What are the changes?  What if
    I keep working?  What are Medicare advantage
    programs?  Could they be right for me? 
  • Select one session to attend
  • Wednesday, October 27, 2010-  10 1130 AM
  • Thursday, October 28, 2010 -  530 PM
  • Friday, November 5, 2010 - 10 1130 AM
  • Receptions Banquet Center
  • 3302 Westbourne Drive
  • Cincinnati, OH 45248
  • The Family Medical Group, is offering a free
    service to provide the Patients of TFMG the
    ability to review different options in regards to
    your health plan choices available for you for
  • How do I register?  One of 3 ways
  • Go to our website
    and click on TFMG news to register.
  • Or email

(No Transcript)
  • invites you to celebrate National Diabetes Month
    at the third annual
  • The Key Ingredients to Living with Diabetes.
  • Thursday, November 11
  • 11 AM-1 PM
  • This free luncheon will feature
  • A panel discussion on diabetes with TFMG
  • Bring a family member or friend.
  • Receptions Banquet Center
  • 3302 Westbourne Dr.
  • How do I register? One of 3 ways
  • Go to our website
  • and click on TFMG news to register.
  • 2. Call 513-389-1400
  • 3.
  • 513-389-1400

(No Transcript)
What defines culture
  • Stories (SeaBiscuit)
  • Language (Florence Yall)
  • Food (Burgoo)

  • Why is there a resurgence of interest among
    today's business and organizational leaders in
    the ancient art of storytelling at a time when
    electronic communications might seem to make it
    obsolete? Human beings have been communicating
    with each other through storytelling since we
    lived in caves and sat around campfires
    exchanging tales. What is new today about the art
    of telling stories is the purposeful use of
    narrative to achieve a practical outcome with an
    individual, a community, or an organization.
  • Storytelling, Passport to the 21st Century

Facts Tell, Stories Sell
  • 4 stories

One doctors Story
  • Story 1

Story 1
  • What are some foundational stories to your
  • If you had to tell one story of how your practice
    began, what would it be?
  • Can you name any dominant themes?

Story 2
  • The formation of practice identity

Storytelling Experience
  • We were deciding about our future.
  • Partnership meeting in which the founding
    physicians of the practice and administrator told
    the story of their beginning
  • Drs. McCarren Bort and Linda Behlmer
  • Foundational principles of the practice
  • Pre-PCMH we had stories, but not a common

  • Confidence
  • Ability to deliver quality medicine
  • Future
  • Physicians
  • Adaptation to changing realities
  • Working effectively in relation to hospital
  • Relationship with other providers helped in the
    development of practice
  • The doctors and the staff created an effective
    partnership in the development of the practice.
  • When it was not right fit, there was a
    willingness to make a change.

  • Confidence
  • Aligning forces in the community
  • Impact of the financial demands of the practice
    to guide strategy
  • New systems within the healthcare environment
  • Challenge of personnel issues
  • Ability to make changes within a larger
  • Responsive to the direction of every group of
    physicians loosely organized as a clinic without

Stage 1
  • Identity

Story 3
  • The formation of team based care

Turning Doctors into Leaders of a Team
  • The cultural barriers to change in health
    caredoctors resistance to being measured, their
    need to be perfect, their reluctance to
    criticize colleagues, their resistance to
    teamworkreflect a deep-seated belief that
    physician autonomy is crucial to quality in
    health care. Doctors have historically seen
    themselves as their patients sole advocates, with
    the rest of the world divided into those who are
    helping and those who are in the way.

Turning Doctors into Leaders of a Team
  • Precious as this passion for patients interests
    might be, physician autonomy is not synonymous
    with quality. For the needed structural and
    operational changesperformance measurement,
    process improvement, teamworkto become
    mainstream, doctors must accept that to
    all-caring is different from being all knowing or
    all-controlling. Thomas H. Lee, MD Harvard
    Business Review, April 2010.

Coumadin Clinic
  • Pro-time clinic within the office
  • Managed by a Physician Assistant
  • Patient experiences a team within a doctors
  • Diabetes
  • Osteoporosis
  • Physical Therapy

Stage 2 Development
  • Team Based Care
  • Pre-PCMH

Name a story of team based care practice.
  • Who was involved in the story?
  • How did you measure the success?
  • How did you celebrate it?
  • Do you know your practice?
  • of patients?
  • 10 diagnostic Codes?
  • Daily, weekly, monthly, annual visits?
  • How do you perform on Clinical measures?

Story 4
  • Language as a key strategy

  • The First challenge in creating a performance
    measurement system is getting everyone across an
    organization to use the same languagethat is,
    to measure the same thing in the same way.
    Otherwise its easy, and understandable, for
    resisters to challenge the validity of apparent
    differences. But once providers believe that
    apples are being accurately compared with apples,
    peer pressure and other incentives will help
    spread best practices. Thomas H. Lee, MD,
    Harvard Business Review, April 2010

The theme for this project is
  • TFMG EPIC Launch To Meaningful Use and Beyond!

Launch of a new EMR
  • Not just an EMR
  • Process Improvement
  • Identifying waste
  • 5-S system
  • Standardization
  • Change Management

Launch of a new EMR
  • Present EMR is being sunsetted
  • Meaningful use. What is Meanginful use?
  • Established a partnership with a hospital
  • Senior Process Improvement Consultant
  • IT Implementation Team
  • Established a schedule on 15 minute huddles with
    all of our staff over the next four weeks to give
    them a common language

Language School
  • Patient Centered Medical give a context to the
    language of the care of patients.

Language of your practice
  • Do you share a common language?
  • Have you instructed your staff on a common
  • Doctors speak a common language?
  • Patients speak a common language?

  • Physician and staff meetings
  • Weekly email newsletter
  • Doctor Newsletter
  • Information system
  • Clinical review project Senior Process
    Improvement consultant

Stage 3
  • Language and context of a Patient Centered
    Medical Home

Why PCMH is important
Section II
  • The PCMH Journey

Important Foundations
  • PCMH is not about the doctor doing more, but the
    organization becoming more effective.
  • PCMH teaches us that effective/outcome
    driven/patient centered Healthcare requires a
    commitment to data management
  • PCMH challenges us to find a common language. A
    language that providers, staff and, most
    importantly, patients speak.

Why is it important?
  • National certifications will do the following
  • Force you to look at your own practice from
    another perspective.
  • Challenge staff to new competencies
  • Put you in position for possibilities around
    payment reform
  • Open you to new possibilities within your

What is Patient Centered Medical Home?
  • The Patient Centered Medical Home is a health
    care setting that facilitates partnerships
    between individual patients, and their personal
    physicians, and when appropriate, the patients
    family. Care is facilitated by registries,
    information technology, health information
    exchange and other means to assure that patients
    get the indicated care when and where they need
    and want it in a culturally and linguistically
    appropriate manner.

  • There are nine PPC standards, including 10 must
    pass elements, which can result in one of three
    levels of recognition. Practices seeking
    PPC-PCMH complete a Web-based data collection
    tool and provide documentation that validates

  • Personal physician
  • Physician directed medical practice
  • Whole person orientation
  • Care is coordinated and/or integrated
  • Quality and safety
  • Enhanced access
  • Payment

Patient Centered Medical Home
  • On March 30 we submitted a 250 page document to
  • Part of a pilot project
  • Formed a team around the application. Met every
    week at a set time.
  • One person was administrative person for the
  • Donna Hedrick facilitator

Patient Centered Medical Home
  • On March 30 we submitted a 250 page document to
  • Developed a Policy and Procedure Manual for our
    entire organization.
  • Established a program of care coordination

One Guidebook
  • Understand where you are at this point in
    relation to the journey of recognition.
  • Access the online tool of NCQA
  • Internally, what can your system handle.
  • A change readiness assessment.

Find a partner
  • Local Collaborative
  • Health System
  • Partnership
  • Donna Hedrick

  • Technology is an important tool.
  • Have to leverage that investment with the long
    term goals.