Viewpoint Issue 2 Autumnal Equinox 2015

Autumnal Equinox 2015 Volume 1, Issue 2 AUTUMNAL EQUINOX ISSUE - 2015

PERSPECTI VES ON THE BUSI NESS OF HEALTHCARE

QUA LITY & IM PROVEM ENT: Ti p s, Gu i d es an d In t er v i ew s Sh o w Yo u Ho w

What You Need To Know About Value-Based Purchasing

Nurse Practitioners vs Physician Assistants

Protecting Your Practice from Inappropriate Social M edia Use

I NTERPRETATI ONS OF WHAT'S SHAPI NG THE HEALTH CARE I NDUSTRY FOR I NDEPENDENT PRACTI CES

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CONTENTS Volume 1, Issue 2 - AUTUMNAL EQUINOX EDITION 2015

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Welcome

Industry News

Art of . . .

Quality and improvement are themes throughout this issue, both in the content you'll find in these pages and in the exciting new site that we've created to compliment the magazine. Editor-In-Chief, Susanne Madden tells you what's inside and online.

What is Value-Based Purchasing?

. . . Improvement.

VBP is here to stay and contracts and expectations are only becoming more complex. Susanne Madden takes a look at what it all means, and how you make sure you understand it all and that your practice is well positioned to thrive.

From how we look to improve our businesses to how we seek improve our lives, Susanne reflects on the reasons that motivate us and explains why quality and improvement are important components of the Triple Aim.

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Big Impacts

Legal Notes

Pro Tips

The latest Recognition Program from NCQA

Nurse Practitioners & Physicians Assistants

Plan. Do. Study. Act.

Recognition for Patient Centered Connected Care Standards is now open for application.

Julie Wood explains how it works and how PCCC helps close the gap in the coordination of care.

The need to see more patients more efficiently without sacrificing quality of care is a real challenge for practices. Sumi Saxena walks you through some important considerations when hiring NPs and PAs.

Jose Lopez takes a look at how PDSA, a practical tool for testing change by planning it, trying it, observing the results, and acting on what is learned, can assist in bringing about real transformation in your practice.

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Connect

HR Matters

Missed a blog post or tweet? Connect provides a quick recap of what you missed from all our media streams. Didn't know that we blogged, 'booked and tweeted? Join us online!

Social Media Use : What can your practice do to curb inappropriate employee posts without running afoul of the law or becoming known as Corporate Big Brother?

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Payer News

Spotlight We talked to Dr. Shannon Fox-Levine about how she is assisting in the creation of a Florida-specific medical home program to tackle areas where there are significant deficiencies in care.

Mergers & Acquisition: Anthem is buying Cigna, creating the largest U.S. health insurer and decreasing the number of national health insurance players from 5 to 3. So, what happens next for practices?

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Frontlines

Overheard

We bring you comments and stories from the Frontlines interviews from our clients, consultant tales from the field and comments from our colleagues. In this edition, we hear about clients' PCMH transition experiences and meet some new friends.

Whether we heard it at the water cooler or on the conference trail, Overheard brings you snippets from interesting conversations on the hottest topics in health care to the just plain funny happenings at the office.

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Events

Roll Call

From city to city, coast to coast, we are on the move. Get details on the key events and conferences that we'll be attending this Fall that you don't want to miss. See you there!

It's time to take a moment to recognize our current group of clients who just graduated by achieving NCQA's PCMH, PCSP and PCCC Recognition Programs.

FEATURED CONTRIBUTORS

Heidi Hallett

Jose Lopez

Susanne Madden

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Sumita Saxena

Julie Wood

? W ELCOME ?

We are delighted to roll out the second issue of ViewPoint Magazine and with it our new online site www.VerdenViewPoint.com!

Before we dive into those details, we'd like to say a big thank you to our friends and supporters, many of whom provided us with useful and insightful feedback on our first issue.

Going forward we will continue to build on everyone's good advice and develop our digital magazine into the concise publication we aspire it to be.

For this edition, we are exploring themes of quality and improvement, topics central to today's rapidly evolving health care market. Throughout you will find perspective, tips and practical advice on how to navigate your way through these new market challenges.

In addition to our usual contributors, we have expanded our client stories so that you can hear firsthand views and benefit from shared experiences. You can read one of those stories here then check out more online. For this edition we explored transitions to the Patient Centered Medical Home model, which we intend building upon online so that subscribers have a repository of handy tips and inspirations about NCQA's Recognition Programs to help see them through their own transitions.

As always, we hope the imagery on the covers and contained herein will inspire and uplift our readers too. Curious about where those images come from? Find out here.

On this autumnal equinox, wishing everyone a bountiful harvest from their summer labors.

Editor-In-Chief

SUSANNE MADDEN | PRESIDENT & CEO

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VIEWPOINT MAGAZINE ONLINE NOW YOU CAN FI ND US ONLI NE. THROUGHOUT THIS ISSUE YOU'LL FIND LINKS TO EXPANDED CONTENT, VIDEO, IMAGES, TIPS, INTERVIEWS AND MORE. COME EXPLORE!

FRONTLINES WE INTERVIEWED THREE PRACTICES ABOUT THEIR EXPERIENCES IN TRANSITIONING THROUGH AND ACHIEVING NCQA'S PATIENT CENTERED MEDICAL HOME RECOGNITION PROGRAM. CHECK OUT FRONTLINES TO READ THEIR STORIES AND LEARN WHAT IT'S LIKE TO UNDERTAKE PCMH..

VIDEO ARTICLES CAN ONLY EXPLAIN SO MUCH AND SOME INFORMATION IS BETTER EXPLAINED IN CONVERSATION. SUSANNE MADDEN AND JOSE LOPEZ TAKE TO THE COUCH TO DISCUSS SOME TRICKY TOPICS LIKE CONTRACT NEGOTIATIONS, MEANINGFUL USE AND DATA REPORTING AND MAKING THE MOST OF YOUR ELECTRONIC MEDICAL RECORDS. JOIN THEM OVER ON VERDENVIEWPOINT.COM

THE BEST OF . . .

WE'VE SELECTED SOME OF OUR MOST POPULAR ARTICLES FROM THE VERDEN GROUP'S BLOG, PUBLISHED IN OTHER JOURNALS AND MAGAZINES, AND INCLUDED SELECT ARTICLES FROM OUR VIEWPOINT ISSUES THAT YOU CAN DOWNLOAD AS PDFS-TO-GO!

GRAPHIC VIEWPOINT CURIOUS ABOUT OUR COVER IMAGE AND LIKE THE PHOTOGRAPHY YOU SEE HERE IN THE MAGAZINE? YOU CAN READ MORE ABOUT WHO TOOK THESE IMAGES AND WHERE ONLINE HERE.

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? INDUSTRY NEW S ?

Susanne Madden, MBA, CCE | CEO, The Verden Group

What You Need t o Know About Value-Based Pur chasing And Why You Need To Car e

The credit for the 'value-based purchasing' model goes to The University of Michigan Center for Value-Based Insurance Design. Established in 2005, it was set up to develop, evaluate, and promote value-based insurance initiatives in order to ensure efficient expenditure of health care dollars and maximize benefits of care. They studied the impact of health care costs and paying for care 'events', rather than outcomes. The research performed there helped to shape reform, which came in the form of tasking Congress with eight defined principles for "Transforming and Modernizing America's Health Care System?. This ultimately led to the signing into law of the Patient Protection and Affordable Care Act (March 23, 2010).

So what does all that mean to you? The bottom line is that 'Payers' ? insurance companies, employers, and now consumers themselves ? are looking for value for their health care dollars.

Payers and Providers This value is interpreted by insurance companies as holding the line on costs, minimizing unnecessary testing and procedures, and improving patient care coordination in order to reduce fragmentation of care. At the heart of 'value' lies the framework for the patient centered medical home and the Institute for Healthcare Improvement's 'triple aim' of: 1. Improving the patient experience of care (including quality and satisfaction); 2. Improving the health of populations; 3. And reducing the per capita cost of health care.

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While physicians are really the ones tasked with improving the patient experience of care (1), physicians and Payers intersect to improve the health of populations and reduce costs (2, 3). The medical home (and associated models such as patient-centered specialty care, accountable care and clinically integrated networks) help to set up a framework under which care is better coordinated, duplication of testing is minimized, care is less fragmented and better managed according to evidence-based guidelines.

those employees that choose to go to highly rated physicians (or designated medical homes) may have no copay at all versus seeking care from lower rated physicians which may result in a $50 copay or more.

If you are not aware of your Payer ?ranking?,look yourself up in their online physician directories. You may be surprised by what you find.

Examples of Grading Programs United Healthcare?s Premium Designation Program Physicians are graded with one star for cost efficiency and one star for quality. Other designations, such as ?Tier 1?and ?PCMH?have also been incorporated into United?s directories and benefit plan designs.

The result of focusing on these areas has opened up entirely new models for delivering health care insurance. We have seen the advent of health care insurance exchanges, where consumers (individuals) and employers can purchase plans on the open market. These plans have large cost sharing provisions (such as large deductibles and cost-sharing percentage), little to no out-of-network coverage, and no out-of-state coverage.

Aetna?s Aexcel Program Physicians are graded much the same way as United?s program, for cost efficiency and quality. This network encompasses 12 specialties (so far) and will include some major modifications for 2016.

On the provider side, the Payers have deliberately kept these networks ?narrow?,usually only 20 to 30% of their larger networks are allowed to participate, and these participants are selected based on being the cheapest providers in the plan. In addition, the Payers pay providers less for services delivered to patients in these plans, usually 10% less than HMO plans, which typically pay less than PPO plans.

Annually, Payer?s mail out performance results to practices. If you receive a packet in the mail, open it!

Examine the scores and supplied data and check it against your own records. In every case that we have looked at for our clients, we have found errors in the Payers?data. It is very important that you understand these metrics and that you challenge any errors you find there ? your access to patients will depend on it more and more.

Payers are also expanding their direct-to-consumer services and helping patients to manage chronic conditions through the use of special tools like phone apps, insurance employees calling their members to remind them about medications, and working with employers to deliver feature-rich wellness programs in order to remain relevant and useful.

One of the most immediate concerns for physicians is that Payers ?are grading?providers, based on efficiency and quality metrics, usually sourced from claims data. How you score can result in patients having a lower or higher cost share to receive care from you. For example, under some employer plans,

Source: www.nbch.org Physician Performance Measurement & Reporting Introduction

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Hospitals and Providers

driving them up as providers struggle to meet the challenges inherent in managing risk, cutting costs, and improving quality at the same time.

If you participate with an Accountable Care Organization (ACO) then you are already familiar with terms such as 'cost sharing' and are likely to be enrolled in 'quality measure' tracking such as meeting target scores for HEDIS measures. These are examples of ways in which ACOs help to hold the line on costs and also improve quality.

What Can You Do? Those entities and practices that manage quality and risk effectively will be well positioned to create the health care delivery system of the future. For independent physicians, aligning with CINs (either through hospital systems or well-run independent physician organizations) will help to maintain that independence for years to come. One thing is clear ? value-based purchasing is here to stay and contracts and expectations are only becoming more complex.

For practices that means understanding where you fit into a Payers network, understanding your grades and ensuring that you improve them (where you are reasonably able to do so), understanding Payers contracts and the terms under which you are participating, and aligning with entities that have the administrative know-how and expertise to effectively minimize risk and develop better opportunities for shared savings back to providers.

Who gets to determine 'quality' anyway?

You may be surprised to learn that the National Committee of Quality Assurance (NCQA) is the entity that created the Healthcare Effectiveness Data and Information Set (HEDIS), the very same folks that brought you the Patient Centered Medical Home (PCMH) Recognition Program as well as Patient Centered Specialty Care Program and now the Patient Centered Connected Care standards.

However, hospital systems and ACOs are going further than simple HEDIS measures now. As these models have matured, the risk has shifted from Payers to ACOs or hospital-based Clinically Integrated Network (CINs) where the provider of care is now at risk in terms of revenue for failure to meet set targets. This not only shifts economic risk to providers but it puts them in a position of having to be effective risk underwriters, a job that physicians are simply not trained to do.

Therefore, while at the same time that Payers talk about keeping cost down, they are administratively

At some point the cost savings will be producing diminishing returns. When they do, we will be in a health care system that looks much different than today. Make sure that you have positioned your practice to be able to meet the challenges ahead and you will be able to thrive in that new market too.

WHA T YOU NEED TO K NOW - Don't wait. Look up your physician profile now with all of your major Payers and reach out to them to correct or update poor scores. If the data is correct, ask them what you can do to improve your scores and then act on it.

- Align with others or develop new entities if none are working in your best interest. Joining a hospital-based ACO may not be your only option. Explore IPAs and if you don't like what you see, consider forming an independent clinically integrated network of your own. (For more on CINs, read this article by Susanne here) - Begin working toward NCQA recognition - PCMH (primary care), PCSP (specialists) or PCCC (episodic care providers). This will help position you to better coordinate patient care, manage to cost metrics, and improve on an on-going basis over time.

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The Ar t of I m pr ovem ent Some folks are relentless in their pursuit of perfection. And while I work pretty hard to achieve excellent results, I can't claim the same drive. Frankly, it would simply take too much precious time to get something absolutely perfect initially; in that same amount of time, we can achieve something pretty close even though it will leave room for improvement. That's not a bad way to have it though.

Our environment is changing all the time. What is perfect today may be outmoded next year, and obsolete in five. Therefore the advice that I give to our clients at The Verden Group is the same advice that I give to the team - strive for quality and perfect it over time through improvement. We need that room to grow and develop. Rigidity is the death of innovation and certainly does not inspire anyone.

How do you know that a) you've created a quality product or service and b) that you need to improve? Well, other people will let you know pretty quickly if your work is only lack-lustre. Patients will seek other practices and practitioners, clients won't come back for more advice and assistance, and customers will go shop elsewhere. But the need for improvement may be harder to determine. If business is good, there is a tendency to rest on one's laurels rather than push on to produce better results.

One of our favorite ways to assess and tackle improvement is the Plan, Do, Study, Act cycle. Jose has laid it all out for you on page 16, so find your way there and consider what projects you can tackle (at work or at home) And if you want to see what PDSA looks like in practice, we've added a video online from HRHCare that will show you what you need to know. Need further inspiration? Read about how three different pediatric practices achieved NCQA's PCMH status and their lessons learned, and check out Other Voices for inspiring content, companies and people.

Once you've finished exploring all that, drop us a note about what you think we can improve here at ViewPoint Magazine- we're listening!

- Susanne

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? BIG IMPACTS ?

Julie Wood, MSc, CCE | Co-Founder, PCS

The Latest Recognition Program from NCQA Seeks to Improve the Quality of Convenient Care

It is not just physicians that are improving care. The National Committee for Quality Assurance (NCQA) has released a new set of Recognition Standards, which comes in addition to the primary care focused Patient Centered Medical Home (PCMH) and the specialty-focused Patient Centered Specialty Practice (PCSP). These latest set of Standards are called Patient Centered Connected Care Standards (PCCC) and fill the gap for those that are providing episodic care to patients but that do not quite fit under either PCMH or PCSP Standards.

Examples of those entities that may qualify to be recognized under the PCCC Standards are: free standing clinics that are not providing primary care, including but not limited to, urgent care clinics, school clinics, employee health clinics, chiropractic, optometry, podiatry, physical therapy, retail health clinics and even tele-health providers. If you fall into any of these categories and are interested in pursuing Recognition, the first step is to go through the NCQA?s formal eligibility check process to ensure that you qualify. Prior to the PCCC standards, entities such as urgent care centers could not pursue or meet the same level of care coordination that is evident in the patient centered medical home.

While many PCMH practices are able to service patients to the extent that they do not need to go to urgent care centers (UCCs), it is inevitable that patients will continue to go to UCCs or other such ?convenient care? entities from time to time. So here at PCS we welcome these new Standards as a way to improve the quality of care offered by such 10

entities, and by improving the coordination of care and communication between the primary care providers and these episodic care centers.

PCMH and PCSP programs. As with the other programs you must purchase a survey tool for each site; these are priced at the same cost as the other programs at $80 each. And similar to the other programs, each organization pays an application fee, based on the number of sites, starting at $1500 each for 1-50 sites, then $750 per site for sites 51-500 (any sites over 500 are free). Once PCCC Recognition is achieved there is then an option to add sites to your current 3-year recognition at any point during this time, with pricing the same as indicated above.

The Standards As with the PCMH and the PCSP Standards, the PCCC Standards are a site level, three year Recognition program. There are, however, significant differences between the programs. For the PCCC Program there is only one level of recognition instead of three (presumably they want to hold them to a high standard of care coordination), and the pass level is 75 (out of 100) points versus 35 (out of 100) as a current Level 1 pass level with both of the other Programs. There are five standards in the PCCC program instead of the six that we see with PCMH and PCSP, but the essence of the Standards are similar:

We think this is important as the types of organizations that can utilize the PCCC Program are usually ones that have growth potential, such as retail-based clinics and UCCs. This offers a reasonable method to ensure quality across those companies?many sites, not just in select locations.

- Connecting with primary care. The site connects with and shares information with patients? primary care providers and helps them find a primary care provider if they do not have one.

- Identifying patient needs. The site directs patients to appropriate providers, when necessary.

- Patient care and support. The site uses evidence-based decision support in care delivery, collaborates with patients to make care decisions and delivers culturally and linguistically appropriate services.

- System capabilities. The site uses electronic systems to collect data and execute specific tasks.

- Measure and improve performance. The provider systematically monitors performance and carries out activities to improve clinical outcomes and patient experience.

WHA T YOU NEED TO K NOW - PCCC fills the gap between primary care and episodic care delivery through urgent care centers, retail-based clinics, school and workplace clinics and even telemedicine providers.

- The program helps to establish care coordination and information sharing guidelines for providers that typically sit outside of the primary and specialty care frameworks.

- As the program grows, we can expect to see employers and other purchasers requiring the same sort of 'tiering' of these providers as is currently in place for specialties and primary care.

The Cost The costs involved in undertaking this program are not insignificant. First, NCQA are charging for the standards at $50 for a single user up to $600 for 11-20 users, a departure from the free Standards for 11

? LEGAL NOTES ?

Sumita Saxena, JD | Legal Consultant

NPs and PAs: The Legal Considerat ions f or Your Pract ice

The demand for non-physician providers has grown exponentially across the country over the last few years. A Horne Medical Office Staff Salary Survey noted a 68 percent increase in the number of non-physician providers added to hospitals and practices between 2009 and 2013, and there are no signs of this trend slowing down. There are many different reasons for this increase, but at the heart of it is the need to see as many patients as efficiently as possible without sacrificing quality of care.

When assessing how best to integrate a non-physician provider into your practice, it?s important to focus on the qualifications and experience of the nurse practitioner (NP) or physician assistant (PA), but there are also state and federal laws pertaining to supervision and scope of practice, as well as billing rules for third party payers, that should be given due consideration.

The scope of practice and level of supervision required for a non-physician provider depends on their licensure and the laws of the state your practice is located in.

It is common knowledge that the major difference between a PA and an NP is the type of education required. PAs qualify through a more general medical examination and are not 12

"Examining the full impact of any new provider on a practice can make all the difference in a successful outcome."

NPs have a much more of a collaborative role with the physician and can operate for the most part independently, without the need for the physician to be physically present in the office, depending on state law. NPs generally practice in an autonomous manner and usually only have to consult with the physician when they have a question. PAs, however, usually need to practice under the direct supervision of a physician and depending on state law, the physician must be present on-site to supervise.

Generally, co-signature of patient charts is not usually required for NPs, unless the practice desires to implement such a protocol, whereas for PAs it might be mandated by state legislation.

required to complete a residency. NPs generally qualify through an exam more specific to population of focus, such as pediatrics, and have practical experience as an RN before qualifying. Not surprisingly, the scope of practice allowed by applicable state law correlates to the level of education and training required of the non-physician provider. As a result, NPs generally have more latitude in their scope of practice and are able to petition their state licensing board for certain additional responsibilities, such as independent prescribing authority.

On the other hand, PAs may have much more restrictive parameters around what they can or cannot do depending on state law. Depending on the state, PAs may have no prescriptive authority and their duties/scope of practice are defined by state legislation. The American Academy of Physician Assistants (AAPA) breaks down the key elements of PA practice into six items: (a) licensure; (b) prescriptive authority; (c) scope of practice (either regulated by state law or defined by practice); (d) physician on-site requirements (either set forth by law or defined by practice); (e) chart co-signature requirements (depends on state regulations); and (f ) restrictions on number of PAs with whom a physician can practice with or employ.

The rules regarding how a particular type of non-physician provider can be billed varies by payer and is subject to incident-to requirements.

The practice should check with its payers regarding whether particular non-physician providers must be separately credentialed, or whether they can be billed ?incident-to?a physician, provided that your practice meets the incident-to requirements.

In order for non-physician providers to bill for services under a physician?s National Provider Identification number (NPI) at 100% reimbursement, the provided service must meet the restrictive ?incident-to?requirements.

Another key difference is in the level of supervision.

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These restrictions include: 1. The service must be performed under a physician?s ?direct personal supervision?which is defined by Medicare as the physician being present in the office suite and immediately available to provide assistance and direction to non-physician provider while performing the ?incident-to?services.

2. The service provided must be ?an integral, although incidental part of the physician's professional service? meaning that a direct, personal, professional service has already been furnished by the physician to initiate a course of treatment and the current ?incident-to?service being provided by the non-physician provider is therefore an incidental part of the patient?s treatment. This is usually a follow-up visit for a patient.

3. The physician must ?initiate the course of treatment? prior to any subsequent services being provided and billed for on an ?incident-to?basis by the non-physician provider.

The scope of practice and level of supervision for each type of mid-level varies state to state.

Please note: an NP can bill for these services under his/her own NPI number at 85 percent reimbursement, whether or not a physician is present on site. There must also be ?subsequent services by the physician of a frequency that reflects his/her continuing active participation in the management of the course of treatment?. Therefore, under the Medicare ?incident-to?billing rules, the patient cannot see only the non-physician provider for all subsequent care.

Continuing physician involvement in the patient's care must be documented. It is both essential and prudent to conduct thorough and periodic assessments of billing practices for all non-physician providers, based on your practice?s operational needs, to ensure you are compliant with your payer credentialing and ?incident-to?requirements.

Many states require a written agreement with non-physician providers.

What this agreement is called varies by state depending on the licensure level of the non-physician provider. For example, some states refer to it as a ?Collaborative Agreement?when it involves an NP, or a ?Supervising Physician Agreement?if you are hiring a PA. Generally these agreements must be in writing and they must spell out the scope of practice of the non-physician provider, as well as the obligations of the designated supervising physician, as 14

required by your state law. Many states require a copy be sent to the licensing board for approval before the non-physician provider can begin working at the practice. Also, if prescription authority is being granted to a non-physician provider, the practice should make sure all necessary forms are completed and filed with the state in accordance with applicable laws, and that any mandated oversight or review of prescriptions is satisfied.

WHA T YOU NEED TO K NOW

Have a well-drafted employment agreement that includes key terms such as ?noncompete?and ?practice ownership of patient charts?.

Many non-physician providers develop a following with patients and can easily leave a practice and take a patient base with them. Including such terms as a ?noncompete?, ?nonsolicitation?, and ?practice ownership of all patient charts and records?is critical to any employment agreement. With this language in place, you can avoid potential disputes and problems if the non-physician provider leaves the practice for any reason.

Conclusion Without a doubt, there is an ever-increasing importance in utilizing non-physician providers to meet the growing demands of efficiency in healthcare, while maintaining the commitment to quality and excellence within a practice?s operational means. When hiring someone be sure to review legal and billing requirements thoroughly ? examining the full impact of any new provider on a practice can make all the difference in a successful outcome.

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- Be aware that each state has its own rules and regulations - Most states require practices to have 'collaborative' or 'supervisory' agreements in place with mid-levels - Put employment agreements in place with mid-levels to help protect your patient base - Check with each of your Payers as to whether or not they credential mid-levels, if you can bill their services directly under physicians, or if services by mid-levels must be provided 'incident-to' physician services For more information on the differences between NPs and PAs, the rules around scope of practice and level of required physician supervision, please go to the following sites: - www.aanp.org - www.aapa.org

Want th i s arti cl e 'to-go'?

Dow nl oad a PDF v ersi on of i t f rom th e V i ew Poi nt si te h ere

? PRO TIPS ?

Jose Lopez | Senior Consultant

PLAN, DO, STUDY, ACT: Impl ement ing Change in your Medical Pract ice In today?s healthcare marketplace, a tremendous amount of change is happening at a rapid pace. Many of these changes are being driven by quality improvement initiatives and patient-centered outcomes. The ability of practices to effectively implement, measure, and manage change has never been more vital to their success.

One area that many practices could immediately improve upon is being open to change. Ideas for change may come from the insights of those who work in the practice, from change concepts or other creative thinking techniques, or by borrowing from the experience of others. Do you ask for input from your staff and patients? Do you empower your staff to question the process or are they in a ?check-the-box?mentality?

Creating a Culture of Change Many practices are afraid of trying an idea that might fail. While all changes do not lead to improvement, all improvement requires change. Expect some ideas to fail, and be sure to test them in a limited manner before implementing them. This is when the Plan-Do-Study-Act (PDSA) cycle can be an effective tool for executing change in your practice.

PDSA Cycle The Plan-Do-Study-Act (PDSA) cycle is a scientific method adapted for action-oriented learning. Think of PDSA as shorthand for testing a change in the real work setting by planning it, trying it, observing the 16

results, and acting on what is learned. After testing a change on a small scale, learning from each test, and refining the change through several PDSA cycles.

Once the optimum outcome is realized, the team may implement the change on a broader scale, such as a larger group of your patient population or on all the patients in your practice.

Step 1: Plan.

Like Honest Abe sharpening his axe, we?ll spend most of our time focusing on the first and most crucial step in the PDSA Cycle: Planning. At the end of your planning process, you should be able to answer the following questions:

- To evaluate how much improvement can be expected from the change.

- To decide whether the proposed change will work in the actual environment of interest.

- To decide which combinations of changes will have the desired effects on the important measures of quality.

- To evaluate costs, social impact, and side effects from a proposed change.

- To minimize resistance upon implementation.

- What are we trying to accomplish?

- What changes do we think can we make that will result in an improvement?

- How will we know if the change is an improvement?

What are we trying to accomplish?

Give the Reasons.

There are a number of reasons to utilize the PDSA cycle. Before beginning, determine why you are implementing a change and communicate those reasons to your team:

State the Aim. What changes do we think can we make that will result in an improvement? In addition to determining and communicating the reasons for testing out a change, you should make predictions about what will happen and why. Predictions are important, they put results into context by comparing what you thought you would see and

- To increase your belief that the change will result in improvement.

- To decide which of several proposed changes will lead to the desired improvement.

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What are we trying to accomplish?

How will we know that a change is an improvement?

What changes can we make that will result in improvement?

what you actually see. The prediction, or aim, of the change should be time-specific and measurable; it should also define the specific population of patients or other outcome that will be effected.

Examples of effective aim statements are: - Reduce adverse drug events in critical care by 70% within 12 months.

- Reduce waiting time to see a speech therapist by 50% within 6 months.

Develop Measures.

How will we know if the change is an improvement? Measurement is a critical part of testing and implementing changes; measures tell a team whether the changes they are making actually lead to improvement. Plot the data for these measures over time using a run chart, a simple and effective way to determine whether the changes you are making are leading to improvement. The National Institute for Children?s Healthy Quality (NICHQ), has an excellent overview and example of how to use run charts here.

A common mistake many practices make is implementing change by using the ?try it and see?method. When our clients engage The Verden Group to help with change management, we often find they are already doing many quality improvement projects and initiatives, but are not utilizing the PDSA cycle.

Without setting an aim, controlling variables, and measuring outcomes, these well-intentioned attempts are ambiguous and not as effective as they could be. Keep in mind that measures are not just for gaining knowledge; you want to ensure that measurement solely for research purposes is not confused with measurement for improvement, which brings new knowledge into daily use at your practice. The atom Alliance has an excellent worksheet available for download to help guide you through the PDSA Planning Process.

Step 2: Do. Test the changes on a small scale. Record your measures, document any challenges and unexpected observations. It?s okay to test parallel ideas concurrently but don?t intermingle or confuse variables as you won?t be able to tell which change resulted in which outcomes. It is crucial for the necessary resources to be allocated to the change in order to achieve the desired outcomes? make sure that having too few staff members assigned to the plan is not hindering the process. Are there processes that can be delegated to or shared by other members of your team? Human resources may need to be increased in the short-term order to implement the PDSA cycle while maintaining regular day-to-day operations.

Step 3: Study.

Set aside plenty of time to analyze the data and study the results. Many practices make the mistake of not checking results in a timely manner or leaving huge amounts of data to analyze at the end. This is often the

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case when implementing changes to meet Meaningful Use attestation requirements; if you wait until the end of an entire quarter to evaluate measures, it may be too late to correct course when they are not being met. Compare the data to your predictions, then summarize and reflect on what was learned.

Step 4: Act.

WHA T YOU NEED TO K NOW An Exam ple of PDSA in Act ion PLAN:

Refine the change, based on what was learned from the test.

Determine if the change can be implemented or what modifications should be made and prepare a plan for the next test. As with the Scientific Method, if you cannot replicate your results, then the change has not been effective. Be sure to manage your expectations and those of your staff: Do not expect huge and immediate improvements! Changes, especially those related to the culture of your practice, take time and need to be validated in a very open and transparent way to be accepted.

We have a large number of Spanish-speaking patients who have not been to a clinic. We decided to test a clinic with 6 Spanish-speaking patients and 4 English-speaking and we brought in 2 Spanish-speaking outreach workers to serve as translators. We predicted the visits would take longer due to translation and that this could interrupt patient flow.

The Importance of the PDSA Cycle

DO:

The PDSA cycle is an effective and powerful tool to implement, manage, and test changes. By conducting small tests of change with a minimum of risk, PDSA builds confidence. Engaging your team in the PDSA process, especially those who are resistant to change or who are worried about the impact of the changes proposed, will reduce concerns and improve ?buy-in?for new ideas. As pay-for-performance models based on quality improvement initiatives and patient-centered outcomes become the norm for public and private payers, the ability of practices to effectively manage change and measure results has never been more important.

During our next clinic, 10 patients were scheduled. There was one cancellation, 2 "no shows". We saw 7 patients in total and clinic ended an hour earlier than usual.

? ? ?

?

?

?

Do - Carry out the plan - Document observations - Record data

CONCLUSI ON: We tested a clinic with Spanish speakers (6 patients) and English speakers (4 patients) mixed together. We learned that translation did not increase visit time and that our bilingual staff could handle the mix.

?

?

- Objective - Predictions - Plan to carry out the cycle - Plan for data collection

?

- Analyse data - Compare results to predictions - Summarize w hat w as learned

Plan ?

Study

ACT:

?

- What changes are to be made?

- Next cycle?

The translation did not slow patient flow as we had anticipated. We have some bilingual staff and also had a bi-lingual NP fill-in. The outreach worker was only needed once to translate for the provider.

Schedule the next clinic with the same number of patients and only one outreach worker.

?

Act

STUDY:

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Want to see PDSA i n acti on? Ch eck out a v i deo of HRH Care's uti l i zati on of i t on th e V i ew Poi nt si te h ere

- CONNECTTVG BLOG

TVG MEDIA STREAMS

Terminating the Physician-Patient Relationship

Susanne is really looking forward to attending Unusual Intersections, a 1 day gathering of unlikely minds to inspire innovative problem solving across diverse industries. Read more here.

It unfortunately can happen to anyone: You go above and beyond to provide your patients excellent care with uncompromising accessibility, and yet something somewhere goes wrong and the relationship quickly deteriorates. Read more here.

Twitter teaser 'Aware of our new digital magazine, Verden Viewpoint?

Now you can view issues and more on the magazine's new site.

Launching Sept 25th!' Follow us here.

Looking Back: Meaningful Use Stage 1 Audits The ugly truth no one wants to hear: CMS plans to audit one in every 20 meaningful use attesters. Read more here.

Cost per Pediatric Encounter ? from our friends at PMI

In a recent LinkedIn post, Susanne shared her Physician's Practice Pearls article on what the Patient-Centered Specialty Practice recognition program is and its potential. Read more and link with us here.

What does it cost to provide care for each child that comes into the office? Pauli Vanchiere from Pediatric Management Institute gives providers a math lesson and shows how to figure it out. Read more here.

For more healthcare news and views be sure to visit & bookmark our online articles section: www.theverdengroup.com/ category/ articles/

Connect with all our social streams here: www.theverdengroup.com/ connect/ verden-media/

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? HR MATTERS ?

Sumita Saxena, JD | Legal Consultant

SOCI AL MEDI A SENSE A Com m on Sense Policy Can Help Cur b I nappr opr iat e Em ployee Post s

Chances are that many of your company's employees post personal content on the internet. Perhaps they have their own Facebook page, tweet their observations throughout the day, keep a blog, post comments on other websites, upload photos, or chat with others online.

Many employers are hesitant about trying to monitor personal posts and for good reason. Blogs and social media provide a creative outlet, a way for friends to keep in touch, a place to share opinions and be part of a larger community of like-minded people.

They are quite simply personal, and few employers really want to read employees' personal writings or be known as a company that stifles personal expression.

However, not all employees like their jobs ? and even those who do may not successfully navigate the line between appropriate and inappropriate content. An employee blog or post that reveals company trade secrets, threatens or harasses other employees, or slams a company product can present an unmitigated disaster for a company. Even posts that have nothing to do with work can create major trouble if they express extreme or unpopular views, racist comments, or violent fantasies, for example.

A quick look through news reports shows that employees have used social networking sites and blogs to post such things as: 22

- YouTube video showing an employee of a restaurant chain stuffing cheese up his nose ? before putting it on a pizza, - Facebook posts by an employee chronicling his dates with coworkers, - Social media posts by employees of an auto club, commenting on their coworkers' weight and sexual orientation ? and on their plans to slow down the company's roadside assistance to motorists, - A Facebook post by an employee threatening to punch a coworker in the face "before the end of my shift," and - A social media page that a teacher created to communicate with his students, which included nude photos, inappropriate conversation, and curse words.

Generally speaking, as an employer, you have the right to control what employees do with their work time and equipment you pay for. However, when employees use their own computers to express their own opinions on their own time, an employer's legal rights are more limited.

Legal Protections for Employees Who Post Online There are laws that protect an employee's right to speak ? at least about certain topics ? online. These laws include: Off-duty conduct laws. A number of states have laws that prohibit employers from disciplining or firing employees for activities they pursue on their own time. Although some of these laws were originally intended to protect smokers from discrimination, others protect any employee conduct that doesn't break the law ? which might include employee blogging or posting.

Protections for political views. A handful of states protect employees from discrimination based on their political views or affiliation. In these states, disciplining an employee for a political post (for example, one that endorses a candidate or cause) could be illegal.

Protections for "whistle-bloggers." An employee who raises concerns about safety hazards or illegal activity at work may be protected as a whistle-blower (called a "whistle-blogger" if the concerns are raised in a blog).

Prohibitions on retaliation. Many employment laws 23

protect employees from retaliation for claiming that their rights have been violated. If an employee complains online about workplace discrimination, harassment, violation of the Family and Medical Leave Act, wage and hour violations, or other legal transgressions, that employee may be protected from disciplinary action.

So what can your practice do to curb inappropriate employee posts without running afoul of the law or becoming known as Corporate Big Brother? Adopt a policy letting employees know that their personal pages, blogs, and posts could get them in trouble at work, and explain the types of content that could create problems.

Concerted activity protections. The National Labor Relations Act and similar state laws protect employees' rights to communicate with each other about the terms and conditions of employment, and to join together ? in a union or otherwise ? to bring concerns about these issues to their employer. Under these laws, an employee who is fired for posting about low wages, poor benefits, a difficult manager, or long work hours could have a plausible legal claim.

A good online posting policy should explain that, while the practice appreciates that employees want to express themselves in the virtual world, problems may arise if their personal posts appear to be associated with the company or violate the rights of the practice or other employees. Here are some topics you should cover:

Adopting a Common Sense Policy Online posts are easy to write and virtually impossible to retract once published. When employees aren't at work, they probably aren't thinking of the potential consequences of making fun of a coworker's accent or revealing little-known facts about a client. They certainly are less likely to be thinking about work when posting pictures or content about a recent vacation or party they went to. Most likely, they're simply trying to be funny and attract readers.

Use of company resources. Your policy should prohibit employees from using the practice's equipment or network to write or publish personal content, or from doing so on company time.

Company policies apply online. It's a good idea to remind employees that company policies prohibiting harassment, protecting trade secrets, patient confidentiality, and so on are applicable whether an employee makes these statements online or in the bricks and mortar world.

Company name and marks. Your policy should prohibit employees from using the company's trademarks, logos, or other images, and should also 24

prohibit employees from making false statements about the company. If employees choose to identify themselves as employees of the practice in an online post, require them to clearly state that the views they express online are their own and that they do not speak for the company.

Inappropriate disclosures. Remind employees that the company may have a legal duty to keep certain facts confidential, especially important in a practice or clinic environement. If employees have concerns about whether something they plan to post falls into this category, they should raise the issue with a manager.

Inappropriate comments. It should go without saying, but news reports tell us it doesn't: Inform employees that it is inappropriate to make embarrassing or unkind comments about employees, management, patients, clients, or competitors.

Remind them that personal posts can be read by virtually anyone and that they should use common sense when deciding what types of content are appropriate.

Your Practice's Social Media. Also, we recommend having tight controls over who has administrative rights to your practice?s social media pages, such as Facebook, and who is allowed to post on behalf of the practice. This will prevent employees from possibly crossing that line and posting things directly to the practice social media pages that could compromise your reputation with patients and thus create substantial irreparable harm for you and your practice in the community.

A well-crafted policy that clearly sets parameters of what employees can or cannot post online, as allowed by law in your state, will certainly go a long way toward building a positive and productive work environment for your practice and your employees.

DEALING WITH NEGATIVE PATIENT POSTS Sometimes in spite of all your best efforts, a patient may, for whatever reason, take exception to your services and post something negative online, complaining about your practice and the treatment they received. As unfortunate and frustrating as this can be, however, patients are entitled to express themselves freely about their experiences and their dissatisfaction with any particular aspect of your practice.

In other words, they have the right to post and share their review or opinion about the quality of services they received from you and your staff. To avoid a potential breakdown in the relationship that is beyond repair, we recommend reaching out to the patient in person and off-line at first. Talk to them to try and work it out? hopefully you?ll resolve the situation and avoid any further issues so everyone can move forward without incident. If the patient acts in a manner that goes beyond just complaining about your services? for example if they threaten you or your staff and thus raise safety concerns, or they refuse to find any common ground to resolve their complaints? then you may be left with no choice but to terminate them from the practice.

For more information on the recommended steps to follow to undertake patient termination please visit our blog here.

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-PAYER NEW S -

Susanne Madden, MBA

Sumita Saxena, JD

THE ANTHEM-CI GNA MERGER: Cr eat ing t he Largest U.S. Healt h I nsur er

In late July Anthem announced it would buy Cigna for about $54.2 billion, creating the largest U.S. health insurer by membership and accelerating the industry?s consolidation from five national health insurance players to three. The proposed acquisition, the health insurance industry?s largest, came three weeks after Aetna agreed to purchase Humana for $37 billion.

State insurance regulators and federal antitrust authorities are examining how these deals will affect competition for Medicare and individual and commercial insurance. The United States Department of Justice and the Federal Trade Commission have become more aggressive about challenging merger combinations in recent years so it remains a question how authorities will respond.

According to analyses recently released, the proposed Anthem-Cigna merger and Aetna-Humana deal would exceed federal antitrust guidelines designed to preserve competition in as many as 97 metropolitan areas within 17 states. The mergers also would raise significant competitive concerns in additional areas. All told, nearly one-half of all states could see diminished competition in local health insurance markets.

Anthem and Cigna?s Justification for the Proposed Merger In their announcement Anthem and Cigna executives touted the merger as resulting in a company with a much broader base 26

over which to spread costs and expenses, leading to a greater ability to innovate and use technology to benefit patients and providers. They pointed to realized savings of $2 billion, though it will cost $600 million to mesh the two companies?vast networks. A combined Anthem-Cigna would have a total revenue of over $115 billion, with Anthem running Blue Cross plans in 14 states and Cigna offering insurance plans through employers.

The combined Anthem-Cigna company would have about 53 million members, surpassing UnitedHealth Group?s 45.86 million members as of June 30, 2015.

An unresolved question is whether Anthem would violate rules of the Blue Cross and Blue Shield Association, a federation of 36 independent insurers of which it is the biggest member. The Association collectively insures 106 million Americans. Anthem provides coverage to the most people and operates in 14 states. No other Blue Cross member operates in more than 5 states.

They also contended that a merger would create a more balanced, diversified company and it would build on Anthem?s Medicare Advantage enrollment in states such as Texas and Florida. Medicare Advantage Plans being privately run are emerging as rapid-growth versions of the federally funded program for the over-65 population and the disabled.

Additionally, Blue Cross operators are not supposed to compete with one another, but Cigna does compete against Blue Cross members in a handful of states, which would cause controversy in the Association.

The numbers

Impact on providers and consumers

Cigna has 15 million members, and about 80 percent of its business is with self-insured companies which pay it a management fee. It also serves large and small employers, Medicare Advantage customers and individuals.

Within hours of the announcement several U.S. lawmakers and leading physician groups said they feared the pending acquisitions would hurt consumers by raising prices or limiting access to healthcare providers. The AMA released a statement that the lack of a competitive health insurance market allows the few remaining companies to exploit their market power, dictate premium increases and pursue corporate policies that are contrary to patient interests. Physicians have voiced concerns that the proposed merger

Approximately 61 percent of Anthem?s 39 million members are served through self-insured companies, while 15 percent have Medicaid coverage. Large and small group policies comprise about 12 percent of its business, while Medicare Advantage accounts for 1 percent.

27

will put them at disadvantage in negotiations over payment and coverage for the services they provide. It places the combined entity in a much stronger and unequal bargaining position to simply say, ?This is all we?re paying.?There are concerns that collaboration between health plans and providers on innovative payment and delivery models could suffer as the bigger, more powerful payers gains more bargaining leverage over providers.

We hope to see you... at the

Experts are also concerned that Anthem-Cigna would have much more clout to wield beyond just pricing, namely pushing more risk to providers by tactics such as capping payouts on employer policies, and forcing employers to cover any over-the cap claims.

AAP Experience National Conference & Exhibition

There is skepticism over whether fewer choices for consumers in the health insurance sector will result in lower insurance rates. Comparisons are being made to the airline industry and mergers in that industry over recent years, which have resulted in higher ticket prices and fewer choices for passengers in many markets. As one expert noted, insurers are looking to consolidate to benefit insurers, the motivation is not to help consumers.

Oct ob er 24 -27, Washing t on, DC

The impact of the merger likely won?t be felt by consumers for more than a year as insurers have already finalized most of their plans for coverage that starts in January, 2016.

St op by our PCS b oot h # 1139, tell us you saw t his invitat ion and we'll g ive you a litt le som et hing special t o take aw ay.

How to navigate this potential change Now more than ever it is essential to position your practice with insurers and third parties (such as independent physician organizations (IPAs) and clinically integrated networks (CIN) like those now being created by hospital networks), as technologically savvy, patient-centered care providers, able to manage population health and operate as primary or specialty medical homes. As insurers gain leverage in their bargaining power with potential mergers such as this one, your practice needs to offer services in a highly coordinated manner with an integration of technology to show insurers you can hold the line on costs and provide network value. While some analysts opine that the mergers, if approved by antitrust regulators, will 28

For details on t his and ot her up com ing event s we'll b e attend ing please visit our event s p ag e.

create greater efficiencies, the consolidation from 5 major publicly traded insurers to 3 is fueling concern among policymakers and healthcare providers. The fear? Deals such as the Anthem-Cigna proposed merger will undermine the Affordable Care Act?s goal of creating greater private market competition and a robust consumer-choice model. Healthy competition is largely regarded as the key to achieving stronger coordinated-care networks, thus improving quality and reducing costs.

For those employers not large enough to create their own primary care centers, who better than primary care physicians to serve families' needs in a local area? There is relatively low risk in pediatrics in terms of estimating costs associated with managing patient care on an age-specific basis. For adult primary care, condition-specific care would need to be estimated and some caps placed on the amount of care delivered to appropriately risk-adjust for outliers (patients requiring considerably more care than others).

With these mega-companies going after both the consumer and employer markets, independent practices must be more competitive than ever.

For specialists too, the opportunity is a good one.

And if you are a member of a progressive IPA or clinically integrated network, that organization could readily set up its own network to sell services directly to employers. However, you cannot both participate in insurers' networks and offer direct care services; contractual limitations will prevent you from doing so.

Here at The Verden Group we believe that a ?direct care?model is going to be the next advance for practices large enough and innovative enough to go after the employer market too. For employers looking to cut costs and improve the care that their employees and their families receive, it makes sense to cut out the middle-man (insurers).

Therefore, our position on this is: pick one mega-network to participate with and pick off the employers that contract with the other mega-network. You know how to deliver care, the opportunity now being presented is how best to deliver services and assimilate risk and compete directly with the billion-dollar monopolies.

With benefit design being in the hands of employers, they have the ability to carve out non-urgent primary care, and many have already done so, providing clinics on site co-located with employees.

29

?SPOTLIGHT?

?

ON DR. SHANNON FOX-LEVI NE

We interviewed Dr. Shannon Fox-Levine on August 31, 2105, about her experiences in transitioning through the NCQA Patient Centered Medical Home Recognition program, which you can read about here. Dr. Fox-Levine didn?t stop at just improving her own practice, she is now helping the entire state of Florida to benefit from what she learned by assisting in the creation of a Florida-specific medical home program to tackle areas where there are significant deficiencies in care.

?As the chair of our newly re-vitalized state pediatric council, I organized a panel discussion with medical directors of health plans and pediatricians?to explain the primary tenets of the medical home model to an audience of 200 attendees.

?NCQA also regulates the Healthcare Effectiveness Data and Information Set (HEDIS), which is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. Primary care physicians and In her own words: insurance plans can work together to meet HEDIS goals for the insurance plans as they also work toward ?The most valuable outcome for our state was the achieving Patient-Centered Medical Home experience that I personally went through to learn from this process. I am now using it to help the rest of certification. The re-vitalized Florida Pediatric Council is working towards this goal to bring providers and our state in developing a state certified PCMH program. I know NCQA is working on national changes, payers together to achieve common goals?. but we are going to look at what NCQA HEDIS With a clear view of the challenges ahead, the Council requirements are in our state, where we are lacking has laid out several clear objectives to work on. By significantly, i.e. #49/50 states for adolescent bringing the Payers and Physicians together, we immunization rates, and together with the medical suspect that Dr. Fox-Levine is on the right track to directors for health plans (mostly Medicaid managed help make a meaningful impact in Florida, to the care so far), we are developing our own state benefit of all. program?.

Read her full interview here.

30

? FRONTLINES ?

Heidi Hallett | Director of Communications

AN I NTERVI EW WI TH DR. ZYSKI ND: PCMH Challenges and Benef it s

HH: Thanks for taking the time to speak with me today. I know your practice is very busy so let?s jump right in. What do you see as the most tangible benefits of the transition to a Patient Centered Medical Home?

IZ: I would say the most tangible benefit was the holistic approach. It changed our view of how we practice medicine.

We are a busy practice, based out of New York City, and we see a lot of patients. The Patient Centered Medical Home allowed us to view our practice through a different perspective, I?d say.

When you get into the daily routine, it?s hard to see the bigger picture in terms of what the patients need, what the staff needs. It?s hard to see that you have room to improve on your efficiency and in terms of how you practice evidence-based medicine, and how the patient plays a very real role in your practice. Our goal is to provide quality patient care; to take care of our patients from the moment they make the phone call to book an appointment, to the intake when the the patient comes in for that initial visit, until much after the patient leaves.

The care continues with follow up on labs, specialty consultations? it completes that loop and makes sure nobody falls through the cracks. It completes that coordination of care.

PCMH helps with the efficiency of the practice as far as teamwork goes and it really revolves the practice around the patient, which is the way it should be.

31

HH: I like that? completing the coordination of care loop. We hear about the efficiencies so often but even more important seems to be those things that get caught instead of falling through the cracks. If you were to highlight a specific positive outcome or your most encouraging success, what would it be?

on what?s important. We feel the difference. We see the difference. It?s really been wonderful.

HH: That is so great to hear. I think I already know the answer to my next question but if you could turn back the clock, would you make the same decision to transition to PCMH again?

IZ: Yes, we definitely would. Listen, it hasn?t been the easiest process. It took us many months to do it. It requires a lot of resources. We hired two full time staff members to work on quality control and follow up, to really take over the tasks of a medical home. Most doctors, most physicians are very busy in their daily routine. One of the hesitancies we had before embarking on the PCMH transition was do we have the resources? Also, is it worth the resources?

IZ: I would say it?s how we practice evidence-based medicine, the quality of care that it gives the patients. We have a way of measuring it now. You know, when we see our patients with chronic conditions, in the past we would just say, ?OK, come for a follow up visit in six months?and then that would get lost in the shuffle. It was really up to the patient to initiate that return visit. Because of the Patient Centered Medical Home, we?ve taken a few chronic conditions, such as obesity or asthma, and because we?re a PCMH we now have the ability to actually keep track. Now we look through patient files weekly or bi-weekly and see how our patients are doing. We can identify the patients who aren?t being compliant, to identify the patients who need further care, who aren?t quite being treated properly with the current regime that they?re on. I think the patients appreciate it-- they feel it. And we see it. That is probably the most tangible benefit from the medical home as far as how it translates to day-to-day practice.

HH: It is a huge initial investment. It?s a big commitment.

IZ: It?s a huge investment! Huge amounts of time but I think the benefits? the financial benefits, the quality of care benefits, the change in the atmosphere of the practice make it worth it. For sure, I would do it again, no question about it.

HH: Lastly, I?m wondering if there is anything specific that you didn?t like about the process?

IZ: The process is pretty tedious, which is good in a way. You don?t want it to be a simple process. You want it to be prestigious. If PCMH took only two days to do and every practice was a PCMH it would loose its value as far as what we do and what our aim is and how hard we work on it. I think there is real value to the rigorousness of becoming a level 3 medical home and I appreciate that. Overall, it has been a very positive experience and in the next couple of weeks, we?re going to embark on the NCQA PCMH 2014 Standards.

HH: Tell me about one big change you?ve implemented? maybe its something you do with your staff or something that?s really had a big impact.

IZ: The biggest change with our staff is the huddle.

We now have a huddle every morning and we get lots of staff involved in our patient care. It?s not just the nurse brings the patient in and does vitals and leaves the room? she?s very much a part of the team now. We?re very much a unified team.

Everyone has a function, everyone has their utility and everyone is important. The fact that we huddle every morning and we all talk, it brings us closer, it unifies us as a group. We talk about our complex cases and our daily goals, and it really focuses us

You can read more PCM H cl i ent i nterv i ew s onl i ne h ere at V erdenV i ew Poi nt.com 32

OVERHEARD at The Verden Group

"Yes, Llamas! Five of them, in fact."

- Susanne Madden, The Verden Group's CEO Susanne took a trip to Columbia, Missouri, to visit with Tiger Pediatrics. She made some unexpected new friends while she was there. . .

You can meet them too over on www.VerdenViewPoint.com

EVENTS HEAR US SPEAK AT THESE EVENTS TEXAS PEDI ATRI C SOCI ETY

PCMH CONGRESS 2015

PMI

- HOW TO SET UP & MANAGE PCMH/PCSP PROJECTS

- UNDERSTANDING ACO AND PAYERS' VALUE-BASED CONTRACTS

October 1, Sugarland, TX

October 9-11, San Francisco, CA

January 29-30, Las Vegas, NV

www.txpeds.org/annual-meeting

www.pcmhcongress.com/home

pediatricmanagementinstitute.com

- HOW DOES YOUR PRACTICE SCORE WITH PAYERS AND WHY YOU NEED TO CARE?

For more information on all the upcoming events and conferences visit: www.TheVerdenGroup.com 33

ROLL CALL! We would like t o r ecognize t he f ollowing client s who have been diligent ly wor king t owar ds Nat ional Com m it t ee of Qualit y Assurance (NCQA) Pat ient Cent er ed Medical Hom e (PCMH) st at us. We salut e all of your har d wor k and dedicat ion!

- Watchung Pediatrics, NJ - Southwest Pediatrics, CA - Hampton Pediatrics, NY - Beaufort Pediatrics, SC - Olitsa Roth, MD, NY - Kindercare Pediatrics, NY - Catherine Screnci, MD, NY - Pediatric Associates of Brooklyn, NY - Topeka Pediatrics, KS For more information about how Patient Centered Solutions (a division of The Verden Group) helps practices transition through NCQA's PCMH and PCSP programs, go here.

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VIEW POINT ViewPoint is a seasonal publication, distributed digitally Š The Verden Group 2015 Editor-In-Chief: Susanne Madden | Editorial and Production Manager: Heidi Hallett | Creative Consultant: Kim Engler Contributors: Susanne Madden, Julie Wood, Jose Lopez, Heidi Hallett, Sumita Saxena, Photography by: Susanne Madden, Jose Lopez, Heidi Hallett www.Ver denViewPoint .com 35