From Solo Family Physician to a Patient-Centered Medical Home

Robert L. Smith, MD, MSFinger Lakes Family Care

Canandaigua, NY

https://www.fingerlakesfamilycare.comhttp://www.robertsmithmd.com

Redundant and inefficient processes Paper charting Inability to search your patient population Increased wait times Staff and patient frustration Dictation delays

My Workflow Before Becoming a Medical Home

1. Solo practice percentage: 1986, 44%. 2008, 18%.2. All-inclusive nature of the Marcus Welby, MD character is

personified by the Medical Home practice model.3. Solo practice physicians can have a modern lifestyle in

the day and age of hospitalist and team based care.4. Personalized care is the foundation of primary care.5. Implementation of EMR systems can be done affordably.6. Availability and access to care is paramount to overall

cost saving within health systems.

Dispelling the myth of the solo physician

Making “The Leap Of Faith” from the traditional office to a Patient-Centered

Medical Home

Feb 2006, Finger Lakes Family Care founded using Amazing Charts as the electronic medical record and Updox for document management. (0 patients and a 1500 sq ft office)

March 2006, 1st Nurse Practitioner joins practice. July 2009, Invited to become a charter practice of

the Rochester Medical Home Initiative. September 2009, 2nd Nurse Practitioner joins

practice.

Our Journey to a Level 3 Medical Home

May 2010, Migrated to our state-of-the-art offices in Canandaigua. (4000 patients and a 3400 sq ft office)

June 2010, Received Level I PCMH-NCQA certification. Nov 2010, Received Level III PCMH-NCQA

certification. 2011 and beyond: Virtual Visits, Patient Portal, Group

Visits, etc.

Our Journey Continued …

1 full-time MD and 2 part-time FNPs 2 providers daily working as a team 2 LPNs 1 RN Care Manager 1 Clinical Assistant 3 Clerical Associates Provider to staff ratio: 1:3.5

Our Practice Model

Efficient charting and clerical tasks Charts are available to multiple people

simultaneously Open Access Scheduling and “Quick Sick” Visits Increased staff and patient satisfaction Improved efficiency = increased revenues

Examples of EHR, Population Based Management, Patient Portal, Virtual Care, and Social Media to follow.

Our New Medical Home Workflow

NCQA PCMH Certification

Improving quality of care by organizing care around patients

Coordinating care and managing information Early evidence suggests that PCMH improves

quality and returns savings Level 1: 35–59 points and all 6 must-pass elements Level 2: 60–84 points and all 6 must-pass elements Level 3: 85–100 points and all 6 must-pass

elements

Our Practice’s Technology

Population Based Data Analysis

EHR Reporting

Social Media

Virtual Care is telemedicine in the real world! Affordable by patients and small offices! Generic: webcam and internet connection

only! Enhances communication and access! Examples:

Home care nurse in a patient’s home Remote family members brought into an ICU

consult Maternity patient meeting with family

members

Virtual Care Servicesby NowDox

Creation of a Patient-Centered Medical Community

Increased proportion of virtual care visits Increased online services via our Patient Portal Increased revenue directly from patients Hybrid Concierge Model

Being available to patients whenever they want and how you want to be notified!

Next Steps