Primary Care Partners Leverages Technology

March 28, 2008
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Some high school teachers like to post their students’ grades on a bulletin board.

The 45 doctors at Primary Care Partners get the same kind of treatment, courtesy of Medical Director Dr. Kenneth Fawcett.

Fawcett said information technology tracks each doctor’s performance on a myriad of benchmarks for patient care. How many diabetic patients have their fasting blood sugar levels tested quarterly? How many pediatric patients are up-to-date on vaccinations? The information is compiled, ranked and posted where the doctors can see it.

“I refer to it as kind of the wailing board or the wailing wall, the board of shame, because pride and shame are drivers for physicians,” Fawcett said. “They're used to being on top of their game, and when they’re shown that other people are performing better … you introduce a whole other competitive element, and all of a sudden you have people who want to really push their numbers higher. That’s what happened.”

Leveraging information technology for quality improvement is one way Primary Care Partners distinguishes itself, Fawcett said. Primary Care Partners, owned by Spectrum Health, includes 15 locations, all in Kent County, and 60 health care providers, including physicians — 10 of them osteopathic doctors, the remainder allopathic —  physician assistants, nurse practitioners and a nurse-midwife. The doctors focus on primary care, such as family care, internal medicine, obstetrics and gynecology, and internal medicine/pediatrics, and several hospital-based infectious disease specialists are part of the practice, as well.

“There’s a great deal of autonomy at the individual sites, but at the same time there's kind of a global structure that oversees the site,” Fawcett said. “They are individually responsible for, say, populating their staff: How many staff do they need? What type of staff do they need? The compensation model dictates that the individual providers at the sites are responsible for those business decisions, but we don’t tell people exactly what they need to do. It really is a nice blend.”

Physicians are compensated through a revenue-minus-expenses model, he explained. Primary Care Partners provides support services such as billing, while other back-office functions are powered by Spectrum Health.

Physicians decide how involved they’d like to be in the business side of the operation, Fawcett added.

“We have multiple committees and multiple layers, where people can be very much involved in that. On the flip side, we have other individuals who really chose to come to Primary Care Partners because they wanted to get out of the hassles of everyday practice,” he said. “It gives them a great deal of options, and I think that is attractive for a lot of the people we have in our organization.”

Fawcett credited the organization’s Quality Improvement Committee with providing the basis for improvements in the quality measures that are posted on the bulletin boards.

“We look at HEDIS (Healthcare Effectiveness Data and Information Set) data, in terms of where is our performance on a national basis, where is the 90th percentile. We are able to hit nearly every single measure and perform at the 90th percentile, and we've been doing so consistently since we’ve put into place this quality committee about three or four years ago.”

Primary Care Partners also measures itself against results from the area’s two other hospital-owned primary care practices, Advantage Health at Saint Mary’s Health Care and Metro Health’s neighborhood outpatient centers, he said, to ensure it’s performing well on quality measures on a local basis.

The development of information technology tools over the past few years has been an important step in helping practices track quality data, Fawcett added. Throughout health care, measurement of quality indicators is predicated on the use of medical codes to identify procedures in computerized databases. Much of that information is held by health insurances carriers, Medicare and Medicaid.

“Five years ago, we were only able to track the information for only a single insurer,” Fawcett explained. “The number of insurers that are able to give us that information is increasing, and actually, we're launching an all-carrier registry that will allow us to access data and judge performance across every insurance line, so we're really excited about that.”

Primary Care Partners recently signed a contract with North Carolina-based DocSite to handle the registry, he said.

Spectrum Health is reorganizing to put Primary Health Partners and all of its hospital-employed physicians into a single entity called Spectrum Health Medical Group, Fawcett said. It will encompass not just Primary Care Partners physicians, but also those at DeVos Children’s Hospital, in Spectrum’s Urgent Care centers and in occupational medicine, he said.

“They wanted to have a new way of being able to really organize and relate with physicians who are already employees, so they are creating this organization,” Fawcett said. “That particular group may not simply be limited to physicians that are currently employed by Spectrum Health. It may encompass individuals who are looking to more closely affiliate with the hospital, both in terms of the primary care sphere as well as specialty care.

“That’s all kind of a slow evolution into the medical group.”

Primary care is evolving as well, as reimbursements for those disciplines fall and fewer new graduates choose them, Fawcett said.

“The number of people going into primary care is dropping … and a lot of people that do go into some of the disciplines are actually going into fellowships for additional training afterwards,” he said. “Only 8 percent of internal medicine graduates go on to practice. Half are becoming hospitalists. Forty-two percent are going on to fellowship training.”

Hundreds of thousands of dollars in debt at graduation from medical school, many doctors choose higher-paying specialties. Those who do opt for primary care often can’t afford to launch their own practices, particularly with the ongoing expense of ever-changing information technology, Fawcett said, so they join a practice such as Primary Care Partners. He said he expects the practice will grow amid changes that are expected to evolve as medicine struggles to provide care for the aging baby boomer generation despite a shortage of providers.

“When we went through the last reorganization, we had a financial turn-around, which was really pretty slick,” Fawcett added. “But at the same time, we were able to elevate the quality, and that's the thing I am most proud about.” HQX

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