One year ago, Family Practice Management asked its readers to rate their performance on 44 items covering everything from quality to technology to physician wellness. FPM then asked readers to assess how important each of those items is to family physicians’ success. From their results, those who took the test were able to identify areas of strength and weakness in their practices and also find out whether they embodied the characteristics they deemed important. Readers who shared their results with FPM were also able to see how their scores compared with those in similar practices.
How is family practice doing?
Looking at aggregate scores for the first 951 individuals who completed the self-test, FPM found that the following items described the respondents and their practices most:
Adequate insurance protection. Item: “I have adequate malpractice, disability, health and life insurance”; descriptiveness score: 3.4 on a 0-to-4-point scale.
Complete medical records. Item: “Medical records for my current patients are complete, include centralized lists of problems, medications and allergies, and can be read and understood easily by colleagues”; descriptiveness score: 3.2.
A strong network of family and friends. Item: “I have a strong support network of family, friends and colleagues to turn to whenever I need it”; descriptiveness score: 3.1.
Patient communication. Item: “In dealing with my patients, I practice active listening and regularly ask them to show me that they understand what I have told them, for instance by restating my instructions”; descriptiveness score: 3.1.
Continuity of care. Item: “My own patients are almost always seen by me rather than a colleague”; descriptiveness score: 3.1.
Efficient exam rooms. Item: “My exam rooms are stocked and arranged in a way that maximizes my efficiency”; descriptiveness score: 3.
Clearly defined goals and values. Item: “I have clearly defined personal goals and values, and they drive my everyday actions and decision making”; descriptiveness score: 3.
The items that described respondents and their practices least involved primarily technological innovations: using e-mail to communicate with patients, creating a secure practice Web site, maintaining a patient registry to help manage chronic disease care, using a computer system that provides care reminders and using hand-held computers to access clinical information. With the exception of computerized reminders, these items were also rated least important among respondents.
What’s most important?
According to the self-test results, five of the above items that respondents said described them most were also considered among the most important to success in family practice: complete medical records, 3.8; adequate insurance protection, 3.7; strong network of family and friends, 3.6; patient communication, 3.5; and efficient exam rooms, 3.5.
The rest of the items rated most important by respondents were not items they claimed to embody:
Effective staff. Item: “My staff is well-trained (and cross-trained), well-organized, experienced, efficient and productive”; importance score: 3.7.
Work-life balance. Item: “I feel that I have achieved the balance of work life and home life that is right for me”; importance score: 3.6.
Stress management. Item: “I am aware of the stress/anxiety in my life, and I am managing it effectively”; importance score: 3.6.
Patient follow-up. Item: “My practice has systems to document and follow up on abnormal tests, missed appointments and patients who need periodic rechecks. We have made a measurable reduction in errors in these areas during the past two years”; importance score: 3.5.
Effective billing. Item: “Almost all of my claims are error-free, almost all billable services are billed, and regular self-audits help ensure appropriate documentation, coding, billing and compliance with the law”; importance score: 3.5.
Personal health. Item: “I follow a healthy diet and exercise program; I maintain my weight within normal limits, and I neither smoke nor overuse alcohol”; importance score: 3.5.
Draw your own conclusions
Few would quarrel with the themes inherent in the self-test results – that it’s important to hire good people, listen to your patients, take good care of yourself physically and emotionally, bill correctly for your services, etc. Still, it’s possible that some of the characteristics rated as relatively unimportant by most respondents will turn out to be crucial to the future of their practices. This was deliberately designed as a self-help tool, not a statistically valid survey and not a means of revealing Truth.
As a self-help tool, the self-test has a lot to offer to each family physician who takes it. It can help you sharpen your sense of what’s important to you and where your practice falls short. That’s the lens you need to focus your own quality improvement efforts. If you would like to take the self-test for your practice, see the February 2001 issue of FPM.
Results from the FPM Practice Self-Test are shown below, sorted by respondents’ views of their importance to family practice. For each statement, respondents were asked “How well does this statement describe you or your practice?” and “How important is it for family physicians to be able to do this?” Scores reflect a scale of 0 to 4.
|Self-test statements||Descriptiveness Score||Importance Score|
|5. Medical records for my current patients are complete, include centralized lists of problems, medications and allergies, and can be read and understood easily by colleagues.||3.2||3.8|
|44. I have adequate malpractice, disability, health and life insurance.||3.4||3.7|
|15. My staff is well-trained (and cross-trained), well organized, experienced, efficient and productive.||2.8||3.7|
|43. I have a strong support network of family, friends and colleagues to turn to whenever I need it.||3.1||3.6|
|41. I am aware of the stress/anxiety in my life, and I am managing it effectively.||2.7||3.6|
|42. I feel that I have achieved the balance of work life and home life that is right for me.||2.5||3.6|
|9. In dealing with my patients, I practice active listening and regularly ask them to show me that they understand what I have told them, for instance by restating my instructions.||3.1||3.5|
|14. My exam rooms are stocked and arranged in a way that maximizes my efficiency.||3.0||3.5|
|40. I follow a healthy diet and exercise program; I maintain my weight within normal limits, and I neither smoke nor overuse alcohol.||2.8||3.5|
|25. Almost all of my claims are error-free, almost all billable services are billed, and regular self-audits help ensure appropriate documentation, coding, billing and compliance with the law.||2.3||3.5|
|2. My practice has systems to document and follow up on abnormal tests, missed appointments and patients who need periodic rechecks. We have made a measurable reduction in errors in these areas during the past two years.||2.2||3.5|
|39. I have clearly defined personal goals and values, and they drive my everyday actions and decision making.||3.0||3.4|
|30. My practice monitors its financial performance and is making an organized effort to improve performance — an effort that has the direct support of practice leadership.||2.9||3.4|
|31. Our practice facilities are up-to-date, well laid out, safe, and handicap accessible; they meet regulatory requirements, have adequate privacy, ample space and adequate room for growth.||2.8||3.4|
|32. Staff meetings are planned and held regularly, well attended, positive and useful; most attendees contribute to the discussion.||2.5||3.4|
|35. Staff and physician satisfaction is a high priority in my practice. It is measured regularly, and problems are addressed promptly and effectively.||2.2||3.4|
|3. I follow evidence-based guidelines to ensure that my patients receive age- and gender-appropriate preventive services, and my practice tracks performance in this regard.||2.5||3.3|
|29. I know at least basic accounting principles; I understand how to read balance sheets and income statements, and I regularly review my practice’s statements.||2.4||3.3|
|33. Staff members receive performance feedback continually as well as during regularly scheduled performance appraisals, and raises are tied to clearly defined performance measures.||2.3||3.3|
|1. When I ask for a consultation, I always provide a specific, written request, make sure the patient understands the reason for the request and have a reminder system to make sure we follow up when consultants’ reports are not returned promptly.||2.2||3.3|
|26. My practice monitors accounts receivable closely, actively pursues receivables and attends promptly to problems. Receivables amount to less than 1.75 months of gross fee-for-service charges.||2.1||3.3|
|38. My own patients are almost always seen by me rather than a colleague.||3.1||3.2|
|22. Almost all of my claims submitted to payers who are able to accept electronic claims are sent electronically and encrypted or otherwise kept secure.||2.7||3.2|
|21. I can obtain up-to-date, authoritative answers (evidence-based answers, where evidence exists) to almost all clinical questions in 15 minutes or less through resources in my office or on the Internet.||2.6||3.2|
|34. New staff members receive pre-planned orientation and training, including a comprehensive orientation manual, training sessions with other staff members and outside courses as necessary.||2.3||3.2|
|28. We monitor our overhead percentage closely, compare it with figures from an appropriate peer group of practices, and are working actively to reduce it.||2.2||3.2|
|18. My practice has an efficient, integrated, secure, computerized system for billing, accounting, appointment scheduling, medical records, patient education, e-mail and online research.||2.1||3.2|
|27. My practice evaluates managed care contracts before signing, monitors both the income from each contract and the costs we incur in fulfilling it and considers the results in deciding whether to renew.||2.1||3.2|
|13. On the basis of patient surveys, telephone company reports and test calls to the office, we have determined that patients who call my practice almost always get through promptly, are treated courteously and are given correct information.||1.7||3.2|
|17. I almost always begin the day on schedule and end the day on schedule.||2.4||3.1|
|19. I personally use a computer every day for work-related purposes.||2.9||3.0|
|37. My practice works directly with public health departments, pharmacies, hospitals, skilled nursing facilities and other community resources to improve the health of my patients and others in the community.||2.4||3.0|
|36. My practice takes a proactive, positive approach in working with third-party payers to improve payment systems and our working relationships.||2.1||3.0|
|20. Our computer system regularly prompts me or members of my staff to remind patients of needed preventive care and follow-up visits.||1.0||2.9|
|7. We distribute and discuss customized patient handouts at all visits where they are appropriate. We offer patient education courses, and we direct patients to physician-reviewed print and online resources.||2.0||2.8|
|4. My staff and I systematically follow at least one evidence-based clinical guideline in my practice, and we track both our adherence to the guideline and the outcomes we achieve with it.||1.8||2.8|
|8. We regularly solicit patient feedback using a patient satisfaction survey or standardized interviews, and we make changes based on the results.||1.6||2.8|
|11. We have successfully implemented an open access plan that allows any patient to obtain a same-day appointment if desired, even for routine matters.||2.2||2.7|
|10. My practice has analyzed the demographics of our patient base and made a concerted effort to ensure that we offer the services and schedule that best suit our patients’ needs.||1.9||2.7|
|16. My practice’s productivity incentive system takes into account a variety of productivity measures (e.g., RVUs, number of visits, panel size, patient satisfaction, clinical outcomes, revenues), and it motivates both physicians and staff to work efficiently and provide excellent care.||1.4||2.7|
|6. My practice maintains a patient registry for at least one chronic condition listing most or all active patients with the condition. We use the registry regularly to generate reminder notices and reports.||1.0||2.4|
|24. I regularly use a hand-held computer to store and retrieve information of professional importance, such as medical databases, drug references and patient information.||1.3||2.1|
|23. My practice has a Web site that allows patients a secure means of electronic communication with me and/or members of my staff in addition to providing information about the practice.||1.0||2.0|
|12. I keep a list of patients who are interested in using e-mail to communicate with me, and I use e-mail to communicate with them at least occasionally.||0.6||1.5|