The American College of Physicians is testing a new resource that would provide direct assistance to physicians interested in practice redesign.
Starting this month, the ACP's Center for Practice Innovation (CPI) will work with 25-50 small- and medium-sized internal medicine practices to help them prepare for the ever-developing pay-for-performance movement and technology boom, and the complexities of the new recertification process.
“Our belief,” said Dr. C. Anderson Hedberg, ACP president, “is that the financial concerns of physicians regarding the implementation and management of the changing practice environment will be addressed through office redesign, attention to quality innovation, enhanced patient satisfaction, and practice growth.”
Funding for the center was provided in a 2-year, $996,000 grant from the Physicians' Foundation for Health Systems Excellence (PFHSE). “The grant will enable ACP to provide new practice-level support and to test innovative approaches aimed at changes in practice management, physician education and patient safety/disease management, and patient satisfaction,” said Dr. Michael S. Barr, ACP's vice president of practice advocacy and improvement and director of the project.
In an interview, Dr. Barr said the center would be selecting practices from across the country, “probably in regional clusters.” Specifically, it wants to target practices of 10 physicians or smaller–practices that don't always have outside support to improve their practice environment.
“We will aim to have a group of practices that are fairly representative of the types of practices in the United States, and will seek to balance the set of practices based on fairly typical demographic factors,” he said.
The 2-year project includes an implementation phase, during which the 25-50 practices will be actively engaged in practice redesign efforts, Dr. Barr said. “We're not going into these practices with a specific, cookie cutter model,” he said. The idea is to adapt different tools and resources, and put together a “menu” of options for these practices based upon their unique situation. The practices will determine which interventions are right for them.
Success will be measured through data collected for selected clinical measures, as well as patient satisfaction, physician/staff satisfaction, and economic indicators of practice function.
Dr. Barr said the CPI will be urging practices to select clinical measures most appropriate for the populations they serve. The center will encourage practices to use clinical measures endorsed by the Ambulatory Care Quality Alliance. Those measures would allow for “adequate comparisons to be made across practices reporting on the same measures,” he said.
These measurements “will help us assess the outcomes for a final report,” he said. “Based on the lessons learned, we hope that the activities continue beyond this 2-year project.” The CPI plans to convene a steering committee to help guide its progress.
None of the practices will be getting direct monetary assistance from the center, he said. “The assistance will come in the form of on-the-ground consultation, support, giving them tools and services, connection with their peers,” and help with recertification.
For now, the project will be limited only to the selected practices, Dr. Barr said. “Unless we are able to obtain additional funding during this 2-year period, it will be difficult to provide the level of assistance to other practices. However, we'll certainly be sharing information along the way through the new CPI Web site.” ACP's Practice Management Center will continue to provide the advice and support that it currently offers for practices looking for more resources, he said.
The CPI is aware of the American Board of Internal Medicine's work with its practice improvement modules, Dr. Barr said. As it develops its own interventions, the center will be mindful of these developments in recertification.
Although health information technology won't be the central focus of the center's activities, there's no denying that health IT is a good way for practices to generate these types of quality improvement outcomes, Dr. Barr said.
“Health information technology and performance measurement have the potential to improve the consistency of outpatient medicine. This new approach will require some time for assimilation, but the external pressure for rapid change might cause future shock for established practitioners,” commented Dr. William Golden, a professor of medicine and public health at the University of Arkansas, who has also worked on a special liaison panel between the American College of Physicians and the ABIM to develop pathways to recertification.