Archive for June, 2011

14 Observations on Healthcare from a Country Doctor

June 2nd, 2011 by Patricia Donovan

Last weekend I caught the tail end of NPR’s interview with David Loxtercamp, a Maine physician and author of A Measure of Days: The Journal of a Country Doctor. The interview ends with Dr. Loxtercamp’s 14 thought-provoking observations on health:

  • Health is not a commodity.

  • Risk factors are not disease.
  • Aging is not an illness.
  • To fix a problem is easy, to sit with another suffering is hard.
  • Doing all we can is not the same as doing what we should.
  • Quality is more than metrics.
  • Patients cannot see outside their pain, we cannot see in, relationship is the only bridge between.
  • Time is precious; we spend it on what we value.
  • The most common condition we treat is unhappiness.
  • And the greatest obstacle to treating a patient’s unhappiness is our own.
  • Nothing is more patient-centered than the process of change.
  • Doctors expect too much from data and not enough from conversation.
  • Community is a locus of healing, not the hospital or the clinic.
  • The foundation of medicine is friendship, conversation and hope.

The tentative title of his new book is “Conversation, Friendship and Hope.”

Dartmouth Hitchcock Built Medical Home on Road to ACO

June 1st, 2011 by Patricia Donovan

Dartmouth Hitchcock’s path to an accountable care organization began seven years ago, and along the way it created a patient-centered medical home model that is a cornerstone of accountable care. Dr. Barbara Walters, senior medical director, returned to HIN this week to share how Dartmouth Hitchcock’s participation in the CMS Physician Group Practice (PGP) demo has enabled it to greatly improve care and health outcomes while lowering cost.

Today, Dartmouth-Hitchcock (DH) operations include more than 1,000 physicians, 1.5 million outpatient visits and 7,500 employees. DH also boasts three different EMRs, a data warehouse, a patient portal and e-visit reimbursement.

Early on in the PGP demo, DH targeted patients with CHF, CAD, and diabetes; it then developed two ‘super registries’ to monitor both chronic disease markers and preventive care needs in its population.

From its new model sprung new roles that required training for nurses and case managers, with a focus on health coaching, motivational interviewing and bridging care across transitions.

Knowing how much doctors like data, DH created reports “>comparing its MDs’ performance with those of their peers, a process that sparked healthy competition among providers. Dr. Walters also recommends that healthcare organizations seek NCQA medical home recognition to determine not only what they’re good at but to identify areas for improvement.

Asked to comment on CMS’s proposed rule on ACOs that is open for comment, Dr. Walters observed that the 65 quality metrics identified in the Shared Savings Program requirements might overwhelm some organizations. She recommended about half that number, phased in over several years, as CMS did in the PGP demo.

In her closing remarks on leveraging population health management to meet ACO efficiency metrics, Dr. Walters shared that DH will actively pilot the ACO model with Cigna and other payors, noting that “it’s better to be at the table participating in the development of a model than to have one imposed.”