For good preventive care, take burden off physicians
Initiative targets high-risk Medicare patients
An ounce of prevention is worth a pound of cure, goes the adage, and in today’s health care market practitioners are well advised to put that into action. But, seeing that your patients get the preventive care they need is not easy.
"The typical response is to put the blame on the doctor but you have to remember that today’s health care environment is overwhelming to doctors. They already have too much to do," says Beverly A. Collins, MD, MBA, MS, who heads an ambulatory care initiative aimed at improving the quality of health care for Maryland Medicare beneficiaries through the Delmarva Foundation for Medical Care, in Easton, MD.
In her three-year program, Collins is working with physicians to improve the rate at which Medicare patients receive preventive measures.
Among the measures Delmarva is tracking for the general population are the influenza vaccination rate, pneumococcal vaccination rate, and mammography screening. The diabetic population is being tracked for annual HbA1C measurement, bi-annual retinal examination, and bi-annual lipid profiles.
"We are collecting baseline measures to see how the delivery of service is going. These issues have a major effect on morbidity and mortality and that is why they were selected," Collins says.
The purpose of the initiative is to find ways to influence practitioners to improve their interventions to ensure that their Medicare patients receive preventive care.
However, Collins points out, the same techniques can be used for other patients too. "We want physicians to look at all the patients in their individual practice," she says.
In the first year of the study, Collins has been studying the literature and looking at systematic approaches that can help ensure that patients receive the preventive health services they need.
One of the biggest excuses patients have for not getting routine tests and preventive care is "the doctor didn’t tell me." Because doctors have to be concerned with so many things during a patient visit, Collins suggests getting the office personnel involved.
"We favor the multidisciplinary approach where people work together on the measures instead of it being on the shoulder of the doctors," she says. For instance, a practice could develop standing orders for certain procedures, such as flu shots for high-risk patients, or eye examinations for diabetics.
"The office manager can refer to the standing order and make sure the patients get the procedures," she says.
Alternatively, the practice can generate a reminder system, whether it’s by telephone or mail, to notify patients that they need to make an appointment for a mammogram or a lipid profile.
"Reminders are more effective if they come from the patient’s personal doctor, rather than a health insurance plan or a third party like Delmarva," she adds.
During the early stages of the project, Collins is evaluating what kinds of resources the physicians have that will help in a preventive care program. Among the resources necessary for the program to be effective is a code in their electronic records system that allows them to identify targeted patients, a mail merge capacity in their computer to print reminder cards, and a way to track interventions to make sure they are effective.
"We have to deal with reality and what is do-able in real life," Collins says.
For instance, it’s difficult for physicians to monitor the mammogram rates of their patients if they don’t get the reports back. Sometimes the reports go to the patient’s family practitioner but if the patient also sees an obstetrician/gynecologist, the family practitioner may not get the report.
"We are trying to get the parties together to brainstorm ways we can close the loop on those reports," Collins says.
Physicians aren’t likely to buy into a program unless there is a system in place to assure that it is effective, Collins adds.
Some insurers already ask for preventive intervention data but in many cases, it’s someone else besides the doctor who compiles the information. When physicians contract with multiple plans, some of which cover only a few of their patients, the data are not meaningful.
That’s why it’s important to identify all of the practice’s high-risk patients, intervene, and measure the success of the interventions, she adds.
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