FPs Opine on Practice Transformation Network Experience

Responses Will Help Shape Future Projects

May 28, 2019 01:42 pm Sheri Porter

To learn more about physicians' interactions with practice transformation networks, researchers from the American Board of Family Medicine collected and analyzed comments from board-certified family physicians engaged with PTNs and then tapped those responses as the basis for a research article published in the April-June issue of the Journal of Ambulatory Care Management.

[signpost - findings, outcomes, results, answers, conclusions]

The article,(journals.lww.com) titled "Experience of Family Physicians in Practice Transformation Networks," focuses on how 297 FPs described their PTN participation expectations and experiences.

The authors explained that their objective was to understand

  • why physicians joined a practice transformation network,
  • what they wanted to support transformation,
  • what they learned, and
  • what kind of help they received.

"Our intention was to learn from the TCPI (CMS' Transforming Clinical Practice Initiative) process to inform future practice transformation initiatives," they wrote.

Story Highlights
  • To learn more about physicians' interactions with practice transformation networks, researchers from the American Board of Family Medicine procured comments from board-certified family physicians who were engaged with PTNs.
  • Those comments were analyzed and used as the basis for a research article that aims to inform future practice transformation initiatives.
  • Participating physicians responded to four questions that centered on their motivation for joining a PTN, their ideas about what a successful PTN experience would look like, what they learned from their practice assessment, and what services the PTN provided to the practice.  

Corresponding author Aimee Eden, Ph.D., M.P.H., a medical anthropologist and researcher at the ABFM, told AAFP News that the findings represent an early look at the kind of support physicians received, although she noted that the research did not attempt to measure their overall satisfaction with PTNs.

Still, the findings should have lasting value to all family physicians because they can serve as a guide to engaging in future projects.

"Practices will need to transform to keep up with payment reforms and the ever-changing health care system and the reforms that go along with that," said Eden. "They're going to have to keep up just like they do with CME and everything else."

Historical Background

As a refresher, a brief explanation of the CMS project could be helpful here. For those unfamiliar with the term, practice transformation networks are peer-based support groups designed to help physicians transition their practices from fee-for-service to value-based payment. PTNs were developed as part of CMS' TCPI project(innovation.cms.gov) -- a four-year pilot project that ends in September.

The ABFM is participating in the project as one of 10 organizations around the country that was awarded a Support and Alignment Network agreement. As such, the ABFM PRIME Support and Alignment Network(primeregistry.org) directs family physicians to PTNs for enrollment; physicians who chose to use their PTN participation to earn CME from the ABFM were offered the opportunity to describe their PTN experiences via an online questionnaire.

Participating physicians responded to questions of their choosing; between 113 and 215 responses were recorded for each of the four open-response questions.

Questions, Key Findings

What was your motivation for joining a PTN?
Overall, although physicians responded in a variety of ways about why they joined a PTN, patient care -- specifically, improving patient care and patient engagement -- topped the list at 29% of 131 respondents.

"This suggests that improved patient care may be an important framework with which to engage other physicians about practice transformation through the TCPI," noted the authors.

Additional top motivators included an intrinsic desire for broad practice transformation or help with data mining and reporting, and extrinsic motives such as an employer or administrative mandate or fulfillment of ABFM Family Medicine Certification requirements.

What would successful PTN participation look like?
Regarding markers of success, the top responses again centered on patient care, with 59% of 129 respondents noting that they hoped to see improvements in patient care. These were described as improved patient outcomes, decreased hospital readmissions and ER visits, and better use of resources.

Other responses included improved patient satisfaction, shared decision-making and cost efficiency.

"Our findings suggest that it is important to tailor practice transformation messages and support efforts to FPs as related to improving patient care," said the authors.

What did you learn from your practice assessment?
A total of 113 physicians responded to a question about what the practice learned from the PTN practice assessment, and the top answer (35%) centered on general areas for quality improvement.

Other responses included how to report and use data to make improvements and references to team-based care and staff team-building. Nearly a quarter of respondents noted their practice assessment had not yet taken place.

Check Out AAFP Practice Support Resources

The AAFP has created resources especially for family physician that focus on transforming medical practices to synchronize them with value-based health care concepts.

Get started by browsing AAFP TIPS (Transformation in Practice Series) -- which include free and low-cost support to help practice teams implement improvement projects -- and practice improvement checklists that were developed to help guide physicians regardless of where they sit on the transformation spectrum.

What services has the PTN provided to the practice?
The final question asked what support the PTN had provided thus far, and the question garnered 215 physician responses. A total of 45% of comments described informatics and data use such as registries, risk calculators, metrics, decision support and changes based on measurable data.

Other answers included care coordination and on-site coaches and consultants.

Researchers noted, "Physicians' perception about the PTN practice assessment process may be reflective of their stage of practice transformation," and said future investigations could explore whether those perceptions change as physicians work through stages of transformation.

Wrapup

"Our early analyses of PTN participant experiences demonstrate that physicians are receiving support from PTNs to assess their practices and make improvements in the areas of data use, team-based care, workflow and care coordination," wrote the authors. "But it is still unknown whether or to what extent those changes will eventually lead to improvements in patient care, cost and payment reform, and population health -- which are more challenging long-term goals."

Circling back to Eden, she indicated a desire for more information about the level of effort physicians put into PTN participation versus what they got out of it.

"We don't know that information, but it does seem that by joining a network like this, practices are getting some resources that might be difficult to obtain on their own, and they are handed to physicians in an organized way that is tailored somewhat to the practice," she said.

And PTNs or similar networks could be particularly valuable to small and solo practices with limited resources that can't hire extra staff to administer, manage and extract data, added Eden.