Ideal Medical Practices

RI IMPS

• Barrington Family Medicine ( Drs Andrea Arena and Lisa Denny)

• North Kingstown Family Practice ( Dr Lynn Ho)• Primary Care of Barrington ( Dr Greg

Sadovnikoff)• Dr Solmaz Behtash• Wickford Family Medicine ( Dr John Machata)

Primary care burnout

• 30% of primary care doctors age 35-49 and 52% age >50 plan to leave their practice within 5 years

• Half of surveyed primary care physicians report at least one symptom of burnout

Fewer primary care physicians

• 44,250 full-time-equivalent (FTE) physicians will be lost from the workforce

• More than 50 percent of physicians will cut back on patients seen, work part-time, switch to concierge medicine, retire, or take other steps likely to reduce patient access

• • A Survey of America’s Physicians: Practice Patterns and Perspectives 2012

Fractured care

• 50 % of patients leave doctor’s office without understanding the advice their physicians gave

• 42% of primary care physicians report not having adequate time to spend with their patients

• In one study 25% of visits patients were unable to express their concerns at all

What is an IMP?

A practice model designed to • enhance doctor-patient relationships • increase face-to-face time between doctors

and patients • reduce physician workloads• instill patients with a sense of responsibility

for their health• cut wasted dollars from the entire system

What is IMP?

• Ideal Micro Practice (IMP): the smallest functional work unit* capable of delivering superb care in a vital and sustainable environment.

• IMP : Ideal Medical Practice: not necessarily limited to care provided by solo physician practices.

IMP principles

• Superb care is “good collaborative care.” Good collaborative care results in:

• improved markers of chronic disease management

• increase patient satisfaction with the experience of care

• lower total cost of health care.

IMP principles

• The components of good collaborative care include:• Superb access: continuous healing relationships and

not just “office visits”• Superb efficiency: patient time is not wasted• Superb continuity: patient knows their physician/care

team and visa-versa. • Access to excellent information from which the

patient can make good decisions regarding their health

• The confidence to make good decisions

IMP principles

• Relationship based : doctor/ patient • Access: email, phone, pager...• Reduce physician workloads: technology

facilitates care• Instill patients with confidence so that they

can take responsibility for their health• Low overhead ( typically 30%)• Measure whole person and practice

IMPs typically have:

• Open access scheduling• 24/7 access by cellphone• E-mail access• Online scheduling• Smaller patient panels• e-Prescriptions• Home visits• Virtual web visits• Web portals

• Performance data via How's Your Health• Telephone coaching

NOT REQUIRED IMP FEATURES

• Solo practice• Small office size• Primary care physicians• No staff• Homemade exam tables and patient gowns• Source of payment (cash, insurance, Medicare,

retainer fee, chickens)

Ideal Care Defined Through Patient Experience:

HOW’S YOUR HEALTH

• “I can get care when and how I need it”• “I have a PCP who knows me as a person”• “My PCP takes care of the bulk of my health

care needs”• “My PCP coordinates any and all care I need”

How are we doing(compared to usual care)

• Twice as many patients who use IMPs report they receive care that is "exactly what they want and need exactly when and how they want and need it" (68% vs 35%).

• IMPs are more likely to have patients report very high levels of continuity (98% vs 88%), efficiency (95% vs 73%), and access (72% vs 53%).

• Patient ratings of very good information (83% vs 67%) and clinician awareness of pain or emotional problem are also higher (87% vs 69%).

Won’t IMPs Increase Primary Care Physician Shortage?

• Increase supply:– Make Primary Care Doctors Happier– Eliminating payment disparities in medical

financing

• Increase practice capacity through extramural support– Telephone coaches– Clinical Microsystems or Teamlets

Primary care shortage

Numbers of Primary Care Providers In the US--2009• Family Physicians--112,000+• Internists--50,000• General Pediatricians--58,000• Nurse Practitioners--100,000• Primary Care Physician Assistants--16,000• Total Number of Primary Care Doctors: 220,000• Total Number of Primary Care Providers: 336,000

• Population of US is about 310,000,000

• Number of Patients/Primary Care Physician: 1409

• Number of Patient/Primary Care Provider: 922

IMP MAP

Resources/ IMP

• Impcenter.org : • Resources for IMPS• Links to efforts to reform health care through

the reinvigoration of primary care• Funded by Physicians’ Foundation for Health

Systems Excellence and The Commonwealth Fund• Advocacy and Research

References

J Ambul Care Manage. 2006 Jul-Sep;29(3):215-21.The emergence of Ideal Micro Practices for patient-centered, collaborative care.Moore LG1, Wasson JH, Johnson DJ, Zettek J.

•J Ambul Care Manage. 2006 Jul-Sep;29(3):215-21.