daniel spogen, md chairman, department of family and community medicine university of nevada, school...
TRANSCRIPT
DANIEL SPOGEN, MDCHAIRMAN, DEPARTMENT OF FAMILY AND
COMMUNITY MEDICINEUNIVERSITY OF NEVADA, SCHOOL OF
MEDICINE, RENO
TO IMPROVE HEALTH CARENEED TO INCREASE THE NUMBER OF
PRIMARY CARE PROVIDERSNEED TO INCREASE THE MEDICAL
STUDENT INTEREST IN FAMILY MEDICINEIMPROVE THE FAMILY PHYSICIAN “ROLE
MODEL”INCREASE THE TRAINING OF PHYSICIANS
IN PRIMARY CARE
DECREASE IN STUDENT INTERESTDECREASED (COMPARED TO SPECIALISTS)
COMPENSATIONPOORLY FUNDED PROGRAMSNEGATIVE ROLE MODELS“UNCONTROLLABLE LIFESTYLES”SCHOOL EXPERIENCES DECREASE
STUDENT INTEREST
MACY REPORT RECOMMENDATIONSINCREASE FUNDINGINCREASE EXPOSURE TO COMMUNITY
HEALTH SETTINGSEXPANSION OF PRIMARY CARE
RESIDENCY PROGRAMSESTABLISH DEPARTMENTS IN ALL
UNIVERSITIESMEDICAL EDUCATION THAT FOCUSES IN
“REAL WORLD” COMPETENCIESIMPROVE THE PRACTICE ENVIRONMENT
FOR PRIMARY CARE PHYSICIANS.
TO INCREASE STUDENT INTERESTPROVIDE EXCELLENT ROLE MODELS ALL 4
YEARS OF TRAININGSHOW STUDENTS HOW TO BE A TEAM
LEADERLESS “HASSLE” IN COORDINATING CARE OF
PATIENTSFAMILY MEDICINE TRACKBETTER LIFESTYLEINNOVATIVE HEALTH CARE DELIVERY
SYSTEMS WITH STATE OF ART TECHNOLOGY
PATIENT CENTERED MEDICAL HOMETWO BASIC PARTS: THE HOME AND
ACUTE CARE COVERAGE.THE HOME: EASY ACCESS, HEALTH CARE
COORDINATOR, CHRONIC DISEASE MANAGEMENT, AUTHORIZATION, TEAM CARE, TECHNOLOGY (E-VISITS, QUALITY IMPROVEMENT, PATIENT PORTALS, E-PRESCRIBING, E-REFERRALS)
ACUTE CARE VISITS
USUAL PAYMENT: HISTORYUSUAL HISTORY IS THAT INSURANCE
COMPANIES EXPECT MORE AND PAY LESSTHE THINGS LISTED IN THE MEDICAL
HOME ARE NOT COVERED COSTS BY INSURANCE, IT IS EXPECTED
50% OR GREATER OF THE COSTS OF PRIMARY CARE ARE THE ITEMS EXPECTED AS A MEDICAL HOME
EVEN THOUGH THE EXPECTATION IS TO OFFER THESE SERVICES, THERE IS NO PAYMENT TO DO SO
IN ADDITION:IF NOW YOU ARE TO ADD STATE OF ART
TECHNOLOGY FOR HEALTH CARE DELIVERYIF YOU ADD MORE SUPPORT FOR TEAM
CARE APPROACHIF YOU ADD TIME TO IMPLEMENT THESE
CHANGESIF YOU ADD TIME TO TRAIN HEALTH CARE
COORDINATORS AND GETTING YOUR MA’s TO WORK AT THE “TOP OF THEIR LICENSE”
YOU NEED “UP FRONT” FUNDING
EXPECTATIONIS TO MAKE THE CHANGE WITH NO UP
FRONT FUNDING OR TIME TO IMPLEMENTTHEREFORE, IT IS SAFER FOR PHYSICIANS
TO CONTINUE TO OFFER CARE IN THE USUAL WAY
HISTORY HAS SHOWN US THAT PHYSICIANS WON’T CHANGE WITHOUT FUNDING AND TIME
MONEY IS NEEDED:TO INCREASE NUMBER OF MA’sTO PROPERLY TRAIN HEALTH CARE
COORDINATORS AND MA’s THAT CAN FUNCTION AS PART OF THE TEAM
TO PURCHASE EHRTO GIVE TIME TO IMPLEMENT EHRTO PROPERLY TEACH RESIDENT
PHYSICIANS AND STUDENTS IN THIS METHOD OF HEALTH CARE DELIVERY
CHALLENGES FOR TRAININGTHE ACADEMIC HEALTH CENTERS HAVE
TO BE THE LEADERS IN MAKING THIS CHANGE
THE FACULTY NEED TO BE WELL VERSED ON THIS KIND OF HEALTH CARE DELIVERY IN ORDER TO TEACH
THE FACULTY NEED TO BE THE POSITIVE ROLE MODELS TO ENCOURAGE STUDENT INTEREST IN PRIMARY CARE
SPECIFIC TEACHING GOALSIMPROVE AMBULATORY TRAININGTEAM BASED CARE IN PATIENT MANAGEMENTPATIENT EDUCATION TO ENCOURAGE SELF-
MANAGEMENTINCLUDE HEALTH DISPARITIES: CULTURAL,
DISADVANTAGED AND RURALSHOW BEST PRACTICES IN PATIENT CARESHOW INNOVATIVE AND TRULY BRILLIANT
CAREPOSITIVE ROLE MODELS
COMPETENCIES TO BE TAUGHT(JOINT PRINCIPALS)PERSONAL PHYSICIANDOCTOR DIRECTED CAREWHOLE PERSON ORIENTATIONCOORDINATED/INTEGRATED CARE THAT
INVOLVES INFORMATION TECHNOLOGY, CHRONIC DISEASE REGISTRIES, INFORMATION EXCHANGE
NECESSARY ATTRIBUTESLEADERSHIP OF PATIENT CARETEAM WORKCULTURAL COMPETENCYDISEASE PREVENTIONHEALTH PROMOTIONSHARED DECISION MAKINGIMPROVED OFFICE ENVIRONMENTIMPROVED HEALTH OF THE COMMUNITY
CONCLUSIONSSTUDENT INTEREST IN PRIMARY CARE NEEDS TO
BE INCREASED BY PROVIDING TRAINING IN IMPROVED OFFICE ENVIRONMENTS BY POSITIVE ROLE MODELS UTILIZING STATE-OF-THE-ART TECHNOLOGY
FOR THAT TO OCCUR OUR ACADEMIC HEALTH CENTERS NEED TO PROVIDE CARE IN THAT SETTING
FUNDING NEEDS TO OCCUR UP FRONT TO DEVELOP THE MEDICAL HOME AND ONGOING TO CONTINUE OFFERING MEDICAL HOME ATTRIBUTES
THIS WILL ENCOURAGE BETTER HEALTH CARE DELIVERY SYSTEM WITH MORE AND BETTER PROVIDERS TO SERVICE THE HEALTH CARE NEEDS OF OUR STATE