From Solo Family Physician to a Patient-Centered Medical Home Robert L. Smith, MD, MS Finger Lakes Family Care Canandaigua, NY

 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, 1 st Nurse Practitioner joins practice.  July 2009, Invited to become a charter practice of the Rochester Medical Home Initiative.  September 2009, 2 nd 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 Services by 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