How can America's primary care physicians improve their practices and take better care of their patients? At a recent conference, FP Richard Wender, M.D., provided some answers to that question.
Conference on Practice Improvement
Primary Care Will Survive, Says Speaker
By Sheri Porter
• Denver
12/12/2006
After the plenary session, Richard Wender, M.D., left, and Michael Henehan, D.O., of Palo Alto, Calif., discuss the detrimental effects of fast-food advertising on patients trying to improve their health.
"I celebrate the increasing recognition that our health care system is imploding," Wender told an audience of FPs, family medicine educators and other clinicians. "Out of crisis comes opportunity," he added, saying he expects to see a positive shift in the business of medicine in the next five to 10 years.
Wender, chair of the department of family and community medicine at Thomas Jefferson University in Philadelphia, has written and lectured extensively on the topic of overcoming barriers to primary care-based preventive health services and chronic disease management.
He presented a plenary session at the Conference on Practice Improvement: Health Information and Patient Education held here Nov. 9-12. The conference was sponsored by the AAFP and the Society of Teachers of Family Medicine.
Wender was frank about the financial barriers primary care physicians face today. "I am not naive," he said. It's difficult to deliver on pay-for-performance initiatives when no one is paying you do it, he added.
Wender, chair of the department of family and community medicine at Thomas Jefferson University in Philadelphia, has written and lectured extensively on the topic of overcoming barriers to primary care-based preventive health services and chronic disease management.
He presented a plenary session at the Conference on Practice Improvement: Health Information and Patient Education held here Nov. 9-12. The conference was sponsored by the AAFP and the Society of Teachers of Family Medicine.
Wender was frank about the financial barriers primary care physicians face today. "I am not naive," he said. It's difficult to deliver on pay-for-performance initiatives when no one is paying you do it, he added.
System Reform
Wender walked the audience through the broad-based reforms that must be undertaken to make change happen. He called for the elimination of problems that occur when individuals are uninsured, the creation of a system that provides and pays for preventive care, an emphasis on primary care, and the widespread use of systems of care.
Wender also highlighted the need for a reimbursement system that pays for outcomes rather than for volume. He called on states to take the lead with pilot projects, thus creating the environment needed to push for a federal solution.
"I celebrate the opportunity to be part of that debate," said Wender. But the solution involves more than just eliminating the problems of the uninsured. Physicians who accept the challenge to change must be ready for disruptive change in their practices, he added.
Wender also highlighted the need for a reimbursement system that pays for outcomes rather than for volume. He called on states to take the lead with pilot projects, thus creating the environment needed to push for a federal solution.
"I celebrate the opportunity to be part of that debate," said Wender. But the solution involves more than just eliminating the problems of the uninsured. Physicians who accept the challenge to change must be ready for disruptive change in their practices, he added.
Models of Care
Physicians already are experimenting with different models of care in an effort to improve the quality of care they provide to their patients, said Wender. For example, boutique, or concierge, medicine grew from physicians' desire to spend more time with patients and still maintain a good income, he said.
On the other hand, some physicians have chosen to maintain the traditional practice model but to spend more time per patient visit and to see fewer patients in a day. Those physicians almost always see their incomes decrease, said Wender.
A third model involves creating a system of care in which a physician can see more patients. This model creates more caretakers for the patient by leveraging the skills of staff members and other clinicians. It relies on a team approach and allows the physician to maintain a desirable income.
On the other hand, some physicians have chosen to maintain the traditional practice model but to spend more time per patient visit and to see fewer patients in a day. Those physicians almost always see their incomes decrease, said Wender.
A third model involves creating a system of care in which a physician can see more patients. This model creates more caretakers for the patient by leveraging the skills of staff members and other clinicians. It relies on a team approach and allows the physician to maintain a desirable income.
Achieving Quality
Wender laid out some advice -- which he dubbed "Wender's Words of Wisdom" -- designed to guide physicians to that third model.
- Create a value-driven practice that puts outcomes first and be willing to invest in it.
- Be relentless. Improving quality is hard work, so keep your eye on the prize
- Measure the right things, such how many hemoglobin A1c measures were achieved rather than how many tests were ordered.
- Report results. "At the very least, report to each other in an environment that's not punitive," said Wender. No electronic health record? Measure five patients with diabetes or five women older than age 50. "Some results are better than none," he said.
- Try anything, including group visits, open-access scheduling and using resident moonlighters as extra staff. Innovation is the key.
- Reject the notion to "go it alone." Solo physicians should share results with other physicians or partner with a hospital.
"We can do this," he concluded. "Out of frustration comes action." High-quality practices require leadership, investment, teamwork and quality measurement, Wender said. He called on his colleagues to be patient, resilient, cool and calculating, but to never lose their passion.
