Jacoby, Richard, MD

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Jefferson Digital Commons

Pennsylvania Academy of FamilyPhysicians Lecture Series “21 Strategies to Survive in the 21st Century”Richard Jacoby, MDClinical Associate Professor Department of Health PolicyJefferson Medical CollegeOver the course of the past several months, I have had the privilege of addressing familyphysicians in the eastern part of Pennsylvania in a series of dinner CME presentationsentitled “21 Strategies to Survive in the 21st Century.” These presentations have beenmade on behalf of the Pennsylvania Academy of Family Physicians (PAFP).Each year, the PAFP sponsors a series of regional meetings throughout the statedesigned to inform its members on topical areas of importance. During the previoustwo years, the lecture series addressed “Pay for Performance” and “Electronic MedicalRecords. While “21 Strategies to Survive in the 21st Century”1 may seem at first a dramatic assessment of the current state of family physicians, it captures the essence ofthe state of affairs for many family physicians given decreasing reimbursement and the many changes currently taking place in healthcare throughout the state and thecountry. I would like to share with you additional background of the presentations andsome of my observations gleaned from dialogue with  attendees.The theme and title for the lecture were developed by Patricia Bricker, the Director ofPractice Advocacy for the Pennsylvania Academy of Family Physicians and Foundation.The book “Practicing Medicine in the 21st Century,” recently published by the AmericanCollege of Physician Executives and edited by David Nash, MD, Chairman of ourDepartment of Health Policy at Jefferson served as the basis of the content of the presentation. Given the topical, educational and practical perspectives of the book, Patconcluded that this was the perfect vehicle for communicating a variety of importantupdates and messages to family physicians throughout the state.With that, a presentationwas developed which outlined in the introduction our impression of the societal factorscoalescing in a “perfect storm” to drive the current rapid pace of change in healthcare,followed by twenty- one specific strategies to adapt to those changes.Health Policy Newsletter Volume 20  •  Number 4 December 2007 The strategies were organized around the themes used in the five section headings ofthe book, namely: Clinical Management (Quality, Safety, Pay for Performance),Information Management (Electronic Medical Records, E-Prescribing), the PracticeEnvironment (Risk Management, Managed Care, Medicare and Medicaid, DiseaseManagement), Practice Management (Open Access Scheduling, OperationalOrganization, Workflow Process Re-engineering), and Financial Management(Documentation, Coding, Billing, Accounting Tools). Our goal in developing the presen-tation was not only to provide updates on policy related initiatives, but to provide concrete suggestions relating to quality, safety, and practice organization that couldenhance the practitioners’ financial bottom line through enhanced revenue opportunitiesand savings on office expenses through more efficient practice processes. The presen-tation was delivered in such a fashion as to facilitate questions, comments, and interactionbetween and among the presenter and the audience.I must confess that I was surprised to learn of the lack of awareness, preparedness, orimplementation on behalf of the family physicians of many of the major policy initiativesunderway. For example, when questioned concerning their awareness of the existenceof the Physician Quality Reporting Initiative (PQRI-Medicare’s voluntary Pay forPerformance program), approximately 50% responded affirmatively. And while half ofthe physicians had heard of PQRI, only approximately 5% indicated they planned toreport on any of the quality measures. In other areas, approximately 10% of the attendees were using electronic medical records, with the remainder showing littleinclination toward adopting this technology. Electronic prescribing was being utilizedby less than 5% of the attendees. There was little knowledge of the general theme ofconsumer directed health plans. The role of the Institute of Medicine in transformingpublic awareness of quality and safety issues through its two seminal publications“Crossing the Quality Chasm”2 and “To Err is Human”3 was essentially unknown to theattendees. And while many of the physicians were aware of and felt threatened by theemerging trend toward “Convenient Care Clinics,” they generally had little or no insightas to their role in fostering the development of this movement by virtue of their officepractice patterns, and had even less insight as to strategies concerning what to doabout it. As to increasing office efficiency through process re-engineering, the generalreaction was that physicians did not have time for such activities, were not trained tomanage them and could not afford to bring in outside consultants to carry them out.I would like to focus especially on the feedback concerning the PQRI. This is a major policy initiative in this country which I believe has merit on many levels. If the PQRI initiative follows the path of the Hospital Quality Reporting Initiative, it will be first voluntary and then mandatory, and likely tied to Medicare reimbursement rate increases.If the PAFP physicians’ participation in this program is indicative of participation nation-wide, when the program is reviewed after this trial, it will not be considered a success.I feel that this program may have been implemented too rapidly to address the detailsthat will maximize its opportunity for success. Indeed, there are currently two billsbefore Congress, the Voluntary Medicare Quality Reporting Act introduced in theSenate by Sen. Ben Cardin, D-Md. and Sen. Arlen Specter R-Pa., and companion legislationintroduced in the House by Reps. Bart Gordon D-Tenn. and John Shadegg R-Ariz., thatwould give Medicare officials more time to figure out how best to run a voluntary qualityreporting program and prevent the program from becoming mandatory in 2008. In astatement released when the bill was introduced in May 2007, sponsor Sen. Cardin said,“Current law does not provide sufficient time to assess the appropriateness and effec-tiveness of this new system. Nor [does it] take into account the fact that most physiciansand other health professionals have no experience in quality reporting and do not havein place the necessary health information technology and administrative infrastructures toparticipate in a reporting system.”4  In addition, Sen. Cardin noted the difficulties somemedical practices would face if a reporting program became mandatory in 2008.“AcrossAmerica, there are practices that would face tremendous obstacles in meeting suchstandards: they lack the information technology necessary to document and reportstandards in a timely manner; they see patients with economic and language barriersthat will result in higher noncompliance rates; they treat a patient population for whomethnic and racial differences require different clinical interventions than for otherpatients,”Sen. Cardin said.“Ignoring these considerations will not only fail to dramaticallyimprove quality, it will significantly penalize providers who treat the traditionally under-served populations.”Clearly, in this regard, Sen. Cardin has his finger on the pulse of what I have observed inmy PAFP lectures throughout Pennsylvania.If you have comments on this article, please contact me atrichard.jacoby@jefferson.edu.References1. Nash DB, Skoufalos A, et al (eds). Practicing Medicine in the 21st Century, ACPE Press, Tampa, FL, 2006.2. Institute of Medicine, Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New health system for the 21st Century.Washington, DC: National Academies Press; 2001.3. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err is Human: Building a Safer Health Care System. Institute of Medicine. Washington, DC: National Academies Press; 2000.4. RWD Technologies, Inc. Leading Through Continuous Improvement. Presented on August 30th, 2007.Copyright © 2007 by the author. Health Policy Newsletter is a quarterly publication of Thomas Jefferson University, JeffersonMedical Center and the Department of Health Policy, 1015 Walnut Street, Suite 115, Philadelphia, PA 19107. jdc.jefferson.edu/hpn

Pennsylvania Academy of Family Physicians Lecture Series  21st Strategies to Survive in the 21st Century

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Pennsylvania Academy of Family Physicians Lecture Series 21st Strategies to Survive in the 21st Century

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