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Pennsylvania AFP Assists Primary Care Residencies, Practices With PCMH, EHR Initiatives
Residencies Gain NCQA Recognition; Practices Attest to Meaningful Use
But Heilmann, associate director of the family medicine residency at Williamsport Regional Medical Center in Williamsport, Pa., had some disappointing data to share with his residents. Those data were the first to be collected as part of the Residency Program Collaborative, an initiative coordinated and funded by the Pennsylvania AFP in its role as a partner in the Pennsylvania Primary Care Coalition.
The residency collaborative is part of Pennsylvania Improving Performance in Practice, or PA IPIP, a program of the Pennsylvania Primary Care Coalition. In addition to the Pennsylvania AFP, the coalition includes the Pennsylvania chapters of the American Academy of Pediatrics and the American College of Physicians.
The collaborative's twin goals are to improve care at residency program clinics and prepare residents to work in patient-centered medical homes, or PCMHs.
- Thanks, in large part, to the Pennsylvania AFP, a statewide Residency Program Collaborative is helping primary care residents improve care at residency program clinics and preparing them to work in patient-centered medical homes, or PCMHs.
- Many participating residencies are being recognized as PCMHs by the National Committee for Quality Assurance.
- The chapter also is helping primary care practices achieve meaningful use of electronic health records.
Collaborative Opens Residents' Eyes to Need for Improvement
"Getting that information was a real eye-opener," Heilmann told AAFP News Now.
"Now we have residents calling patients up and saying, 'You need your flu shot,' or 'You need to go see your eye doctor,'" Heilmann said. "Unless you're measuring these things and you know what to measure, it's hard to improve."
The Residency Program Collaborative, which began in June 2010, is the largest state residency program collaborative in the United States, according to Pennsylvania AFP Vice President of Quality Initiatives Lee Ann Grajales, who oversees the program.
Chapter Helps Practices Achieve PCMH Recognition
Heilmann's residency practice was one of those that achieved the top PCMH status. "It would have taken a lot more time for us to get NCQA recognition and get our quality improvements off the ground if this collaborative hadn't been set up," he said.
Facts About the Pennsylvania AFP
Number of chapter members: 4,800
Year chapter was chartered: 1948
Location of chapter headquarters: Harrisburg, Pa.
2012 annual meeting date/location: May 18, Omni Bedford Springs Resort, Bedford, Pa.
The baseline data for Warning's residency were "quite embarrassing," he professed. Not unlike Heilmann's experiences in Williamsport, patients with diabetes at Crozer-Keystone were not always getting eye exams, foot checks and urine checks, for example.
"We were at the 50th percentile for patient care," Warning said. "Now we're at the 80th and 90th. That's gratifying.
"We can prove now that we provide higher quality of care, especially for diabetes. We know patients are getting better outcomes, just in our lab outcomes."
Warning said he hopes to someday prove that, within certain predetermined health care parameters, coordination of care will result in fewer overall acute problems, fewer hospitalizations, and -- specifically for patients with diabetes -- fewer amputations and cases of blindness.
Program's Impact Reaches Beyond Residencies
"It's a rude awakening when they graduate," he said, noting that it's still difficult to find a family medicine practice that has achieved PCMH status. According to the NCQA, 2,710 primary care sites staffed by 13,728 clinicians nationwide had been recognized as primary care medical homes as of August 2011.
"What we're doing is getting these young doctors of tomorrow while they're still formulating their habits and behaviors," Grajales explained. "Patient-centered medical homes and the chronic care model have been proven to improve patient care and the health of the patient specifically as it relates to chronic conditions."
In addition to funding the collaborative, the chapter coordinates monthly team meetings, learning sessions, and a performance improvement tracking tool to monitor and analyze the data collected by participants.
"We couldn't have done this without the PAFP," Warning said. "They are the backbone of our collaborative."
PAFP Supports Other Quality Improvement Programs
For many practices, a preliminary step in becoming a PCMH is adopting an electronic health record, or EHR, system, and the Pennsylvania AFP offers support to these practices, as well.
Currently, the chapter is working with 400 health care providers to aid them in achieving meaningful use status and qualifying for CMS' EHR incentive programs, said Grajales. As a subcontractor for the PA REACH program (Pennsylvania Regional Extension and Assistance Center for Health Information Technology), the Pennsylvania AFP has already directly helped 29 providers attest to meaningful use status in the past year.
Depending on the needs of a given practice, the chapter may assist with a request for proposals, conduct workflow analyses, intervene with vendors or teach staff how to run the necessary reports, Grajales said.
James Chlebowski, M.D., a family physician in the practice's Selinsgrove, Pa., location was one of the doctors who attested in July.
"It's improved efficiency," Chlebowski said. "If a patient is seen in another office, that (fact) shows up in my office; it makes it easier to have access to the full record."
In addition to improving patient care, attesting to meaningful use also has financial benefits. Those who achieve meaningful use, for example, can receive as much as $44,000 in incentive funds in a five-year period from the Medicare EHR Incentive Program.
The bottom line for the Pennsylvania AFP's 26 staff members, Grajales said, is to be on the forefront of primary care.
"If there is a health care initiative in the state of Pennsylvania, we're going to be part of it and leading it," Grajales said. "Our goal is to be an innovator and a contributor to health care transformation across the country."
Chapter Spotlight series
Pennsylvania AFP Assists Primary Care Docs With PCMH, EHR Efforts