IT key in AAFP model physician office

Health Management Technology, Jan, 2005

Information technology will play a critical role in a pilot project that will show how a new model of healthcare can improve quality, decrease costs and increase physician efficiency and income.

The American Academy of Family Physicians (AAFP) is funding the $8-million, two-year project to pilot test a new model of care--which prominently features information technology--among 10 to 20 family medicine practices of varying sizes across the U.S. A New Model Practice Resource Center, a wholly-owned, for-profit subsidiary of the AAFP, will develop, implement and evaluate the pilot.

The Center's board of directors will determine criteria for selecting practices by the end of January, then select 10 to 20 practices by August. It expects to roll out the project by September and to publish final results by late 2007. Practices selected for the pilot will receive free software technology, training, support and evaluation services.

AAFP's new model of care is based on a "relationship-centered personal medical home," and comprised of 11 key characteristics, including IT systems. "At the core of the patient's healthcare is a family physician they can trust," says Dr. Michael Fleming, AAFP board chair. In focus group interviews conducted during development of the model, IT systems (including electronic health records), ranked third in importance to patients. First and second most important to patients were seeing the family practice as their personal medical home and seeing a commitment from the practice to provide a defined set of services.

Fleming identified key areas where IT solutions can generate productivity gains: online scheduling of appointments by patients, including the flexibility for patients to see the doctor within 24 hours; EHRs; and electronic programs that prompt patients into services such as immunizations and blood pressure checks.

Fleming projects that the new model will provide fiscal gains for practices, whose profits are being squeezed. He cites an MGMA survey that shows that physician productivity outpaced increases in compensation for three straight years from 2001 through 2003.

"They are working harder, putting in longer hours, and their overhead keeps going up," Fleming says of physicians. "Increasing expenses and declining reimbursements are forcing many primary care physicians out of practice."

AAFP financial models show that by implementing the new model of care, a typical five-physician practice could increase productivity enough to expand the time they spend with each patient or to reduce hours they work by 12 percent. Alternately, the physicians could use the extra hours to see more patients and increase their compensation by up to 26 percent.

While the academy projects a rapid return on investments for most practices, Fleming warns that transition to the new care model will not be easy and practices will incur transition costs. AAFP estimates the transitioning costs will range from $23,442 to $90,650 per physician, depending on the temporary productivity loss associated with implementing an electronic health records system. At those levels, a physician could expect to recoup his transition costs in one to two years.

Fleming cautions that EHRs are still in their infancy, although the software has been around more than 20 years. "Many of today's EHRs do not consider the flow of work in a family physician's office," Fleming challenges. "I would like to see an EHR that takes into account that the typical PCP deals with about 250 diagnoses (compared to a specialist dealing with only 30 or so diagnoses). I'd also like to see an EHR designed by a family physician and an industrial engineer with a critical eye for getting from A to B without having to go through C, D, E.

"Family physicians are saying they want exactly what patients want to spend more time with patients and less time pushing paper," Fleming says. "The new model of care, with its emphasis on electronic health records and advanced information systems, can make that wish a reality." For more information or updates throughout the pilot project, visit www.aafp.org.