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1)
Describe the specifics -- what does a group practice look
like? What specifically are we talking about here?
How would you define this?
• Multispecialty
medical groups are teams of physicians from a range of specialties
who practice together. These groups include primary care
doctors, specialists, health educators, nurses, dieticians,
and all the other care givers you might need to help keep
you healthy.
• Larger multispecialty medical groups will have access
to nearly all the types of medical specialties one might
ever need.
• They collaborate with each other and their patients
in order to improve clinical outcomes and overall health.
• These groups share facilities, equipment, finances,
and medical information. They also share the responsibility
for all of their patients and are committed to the team
practice of medicine.
• Doctors of multispecialty medical groups communicate
with and consult team members regularly. This increased
doctor-to-doctor contact means the care one receives is
coordinated and responsive to individual patient needs.
2) How is it different from the doctor I currently see?
Why is this better than the traditional medical delivery
systems I know? What are the key hallmarks of this model?
• The
doctor you currently see is most likely a very competent
and trusted professional, but if he or she works in a small
or solo practice, your doctor lacks several specific advantages
that the competent and trusted professionals who belong
to multispecialty group practices can offer you:
Teamwork
• Your doctor may practice in a facility with other
doctors, but that doesn’t mean he or she is part
of a coordinated group.
• Unlike your current doctor, an Accountable Physician
Practice or multispecialty practice doctor not only shares
office space or the purchase of supplies, he or she is
part of a larger team of doctors.
• This team means that you as the patient are at
the center of a group of doctors who are specialists in
different areas of medicine.
• Depending on your condition, they coordinate the
care around you so that you receive the best treatment
for you as a whole, not a series of symptoms.
• Typically, the burden rests with the patient to
connect his or her cardiologist, urologist, endocrinologist,
nurse practitioner, and psychologist together. In an Accountable
Physician Practice setting, these specialists automatically
work as a team for you. That’s what sets them apart
as a multispecialty medical group.
Communication
• Your doctor may make use of e-mail and computers
but probably no differently than she does in his or her
own home.
• Doctors who practice together in an Accountable
Physician Practice, on the other hand, use advanced technology
that allows them to share and have quick access to all
types of information from their office or from their home;
♣ Electronic Medical Records (EMR) to keep patient
health records current and accessible to all members of
the care team;
♣ Automated drug interaction alerts that help doctors
keep patients safe by alerting doctors to problems with
prescriptions;
Treatment
• Your doctor may receive several medical journals
in the mail to stay current on important topics, but there
are countless journals that publish new information everyday,
making it nearly impossible to stay completely informed.
• Doctors in accountable multispecialty medical groups
work in a collaborative environment that facilitates the
flow of information, new knowledge, and the latest advances
through the use of effective physician communication channels.
• Doctors are encouraged to share experiences and
use advanced care management tools like drug reminders,
disease registries, and case management.
Value
• Your doctor’s ability to treat you is limited
to the resources that his or her practice can afford.
• While your doctor can always refer you to a specialist
or a local hospital that is “in network” from
an insurance standpoint, if your doctor is not in a multispecialty
medical group, you may be essentially visiting a different
system: your doctor and the referral may not necessarily
know each other or work together on a regular basis. This
gap between doctors means poorer communication about your
needs and potentially less value for the cost.
• Accountable Physician Practices can reduce costs
through simple economics: When groups of doctors share
resources, the burden of cost is spread across many specialists.
• In addition, because of shared communication and
information systems, multispecialty medical groups are
able to coordinate the care you need, which contributes
to a more efficient practice.
• Multispecialty medical groups also practice preventative
medicine, meaning that they approach health and wellness
from a proactive standpoint. Investing time and money
to keep a healthy person well is less expensive than waiting
to treat that same person once they become ill.
• Because doctors in these groups are connected to
each other by means of a shared system, they tend to employ
electronic medical records and implement best practices;
there is generally less waste and duplication of efforts
and fewer costly mistakes.
• For the patient, you have fewer duplicated costs
or procedures and better awareness of your needs across
the system.
• The result is a greater coordination of resources,
which means greater efficiency and ultimately more value
for each dollar spent.
Future
• While you may not be aware of it, coordinated care
is already being practiced all over the country.
• There are approximately 250 large physician groups
nationwide.
• There is a strong base of multispecialty medical
group practices off of which to build. Group practices
of over 100 physicians are located in every region of
the U.S., with a notable concentration in the upper Midwest
and far West.
• About 80 percent of Americans live in places that
could be served by a large multispecialty physician group.
3) Why is having an electronic medical record an advantage?
• Most
of our health needs are never simple enough to concern only
one health professional, whether a doctor, nurse, therapist,
or dietician.
• Ensuring that each health care provider has access
to the latest information in a patient’s record is
vital, and only an electronic medical record (EMR) can provide
that.
• Traditional paper-based systems mean that a patient’s
record is stored in a central physical location; the record
must be retrieved each time it is needed. Consuming this
much time to access patient information is not just inefficient,
it could be harmful to the patients’ health.
• Lives are lost and saved in seconds—with EMRs
more lives can be saved.
• By having our medical records digitized and stored
in a location accessible by our health care providers, we
as patients will have greater access to the care we are
receiving and information about the condition of our health.
• Some Accountable Physician Practices or multispecialty
medical groups, like Geisinger Clinic in Pennsylvania, have
already developed web interfaces for their patients. Imagine
being able to view your lab results from home!
• Also, because no one ever plans for illness, we hardly
think about our health when we are away from home. But if
you are separated from your doctor by many miles or circumstances—as
the New Orleans residents were after Katrina--doesn’t
it make sense that your medical information can travel great
distances instantaneously?
4) Why are Accountable Physician Practices and multispecialty
medical groups better at caring for diabetes / CHF / asthma
/ chronic conditions?
• Chronic
conditions, which are by nature complex, require a great
deal of frequent monitoring by several different specialist
doctors and nurses, and multispecialty medical groups can
provide this.
• A diabetic patient may be connected to a team that
is comprised of a primary care physician, endocrinologist,
diabetes educator, care manager, behavioral health specialist,
home health nurse, and health center staff. Because diabetes
and conditions like it are more complicated than other short-term
conditions, they require constant coordination of team care.
• The team can manage the care of all the patients
with diabetes across all of their needs, including preventive
outpatient care, inpatient care, home care, and long-term
care.
• In addition to managing chronic conditions through
the type of teamwork that is only possible in a group setting,
multispecialty medical groups also frequently employ special
care-management processes that ensure that all of the patient’s
health and lifestyle factors are taken into consideration.
• Because Accountable Physician Practices use information
technology, they can identify diabetic patients, for example,
within their network so that diabetic patients
receive care that is specialized for their condition at every point.
5) Why would an Accountable Physician Practice or multispecialty
medical group be better at caring for me if I'm generally
healthy? It seems to me that I would be better off going
to a big group of specialists if I have a specific problem
(such as an orthopedic group for an old knee injury or a
big ophthalmology group for a cataract). I can usually tell
what my problem is -- what's the advantage of a multispecialty
medical group?
• It’s
true that multispecialty medical groups are especially good
at caring for chronic illness, but for those same reasons,
multispecialty medical groups are also especially good at
caring for less complicated diagnoses.
• Multispecialty medical groups are better for people
who are basically healthy because their practice of medicine
focuses on keeping people healthy, not just treating them
once they’ve fallen ill.
• This type of care is called preventive medicine,
and it is a proactive approach to health and wellness that
controls costs.
• Investing in maintaining healthy people, through smoking
cessation programs, prenatal counseling, and nutrition classes,
means fewer costly health problems like lung cancer, pregnancy
complications, and disease related to obesity later on.
• When people stay healthier, it costs everyone less
money and less suffering.
• In addition, our health is not always as simple as
“one problem.” Often a symptom that may be tolerable
today is an indication of a more complicated problem that
is only now developing.
6) Why does it matter if my different doctors all work for
the same place? How does that make my care better? What
do you mean by "team-based" care, and why is it
important?
• A
group practice of doctors not only shares an office space
or the purchase of supplies, they function as a unit. Each
individual doctor is one part of a larger team of doctors,
which means that you as the patient are at the center of
a group of doctors who are specialists in different areas
of medicine.
• Depending on your condition, they coordinate the
care around you so that you receive the best treatment for
you as a whole person, not a series of symptoms.
• In a typical situation, the burden rests with you
to connect your cardiologist, your urologist, your endocrinologist,
your nurse practitioner, and your psychologist together.
• In a group setting, these specialists automatically
work as a team for you. That’s what sets them apart
as a multispecialty medical group.
• Doctors who practice together in a multispecialty
medical group also use advanced technology that allows them
to share and have access to all types of information;
• They work in a collaborative environment that facilitates
the flow of information, new knowledge, and the latest advances,
and they are also encouraged to share experiences and use
advanced care management tools like drug reminders, disease
registries, and case management.
• A single doctor or a small group of doctors is limited
to the resources that their small practices can afford.
• While these doctors can always refer you to a specialist
or a local hospital that is “in network” from
an insurance standpoint, you are essentially visiting a
different system: your doctor and the referral do not necessarily
know each other or work together on a regular basis.
• Multispecialty medical groups also practice preventive
medicine, meaning that they approach health and wellness
from a proactive standpoint. Investing a smaller amount
of money to keep a healthy person well is less expensive
than waiting to treat that same person once they have become
ill.
• The result is a greater coordination of resources,
which means greater efficiency and ultimately more value
for each dollar spent.
7) How do Accountable Physician Practices reduce costs or
improve efficiency?
• Through
simple economics: When groups of doctors share resources,
the burden of cost is spread across many specialists.
• In addition, multispecialty medical groups are able
to coordinate the care you need, which contributes to a
more efficient practice.
• Because doctors in these groups are connected to
each other by means of a shared information and communications
system, they tend to employ electronic medical records
and implement best practices; there is generally less waste
and duplication of efforts and fewer costly mistakes.
• As the patient, you have fewer duplicated costs
or procedures.
• The result is a greater coordination of resources,
which means greater efficiency and ultimately more value
for each dollar spent.
• Multispecialty medical groups also practice preventive
medicine, meaning that they approach health and wellness
from a proactive standpoint. Investing a smaller amount
of money to keep a healthy person well is less expensive
than waiting to treat that same person once they have become
ill. This results in more value for each dollar spent.
8) Doesn't a solo practice or small practice doctor have
access to the same "breaking health news" and
use that in caring for patients?
• In
theory, any one doctor does have equal access to the latest
information, but in practice, the case is quite different.
• The volume and speed at which new information is
constantly made available to the medical community would
easily overwhelm one, two, five, or even ten doctors if
they tried to keep tabs on it all.
• Multispecialty medical groups have the infrastructure
and support to access the newest information, summarize
key points for their doctors to learn, and disseminate the
information their clinicians.
• In addition to having the advantage of sheer numbers
for staying abreast of the latest research, physician groups
are also better at turning theory into practice.
• Because of their use of care-management processes, a
group can assess a new treatment and alter its practice
more efficiently.
9) How can I be sure I'll find a doctor in a group that
I'll like and trust?
• Trust
is an essential element for any doctor-patient relationship,
but in multispecialty medical groups, it is a cornerstone.
• Every patient has individual needs both physically
and emotionally. Because doctors who strive to provide
coordinated care practice medicine with your entire body
in mind, they are particularly sensitive to a patient's
many and varied needs.
• Multispecialty medical group doctors are not only
extremely competent; they are also extremely collaborative,
working not only with each other, but also with you the
patient.
• Because this spirit of teamwork is fostered within
multispecialty medical groups, you can be confident that
every doctor will treat you with respect as an individual
and work to earn your trust at every step along the way.
10) How could this model possibly be useful to transform
the U.S. health system when most of the doctors in the U.S.
are in solo or very small practices?
•
Changing the U.S. health care system is no small task, but
obviously it is a worthy one. While most doctors are practicing
in small groups or solo practices today, the opportunity
to grow the number of large multispecialty medical groups
is now.
• A critical component of providing quality, coordinated
care is returning the doctor-patient relationship to the
status that it lost during the uncontrolled explosion of
managed care. But doing so means that leadership is needed,
and who else to fill this leadership role than the doctors
who are already demonstrating that they know a better system
than the current norm?
• Multispecialty medical groups are centers for leadership
and change. Whether implementing the best practices or managing
the patient’s health through prevention, these doctors
are practicing the way they believe medicine should be practiced.
• This model is working, and people are taking notice:
the media, health insurance plans, medical students, policy
makers, and most importantly of all, patients. And when the
patients-as-consumers soon realize that multispecialty medical
groups provide the best value for the best quality care,
their choices will influence a market change, thus convincing
doctors that practicing alone is a lonely place.
11) Why should I care about this?
•
The U.S. leads the world in spending, but lags behind other
industrialized nations in areas like infant mortality, obesity,
life expectancy, and patient satisfaction.
• We’re not getting sufficient value for our
spending.
• The growing burden of chronic illness and an aging
population makes this problem even more critical.
12) I am paying more as a business for employee health benefits,
and my employees are paying more out of pocket for the same
thing. What will this do to help?
•
When teams of health professionals share resources and patient
knowledge, it becomes far easier to know what works best,
and to assess the value of individual treatments.
• Because doctors have the right technology and greater
incentive to improve performance, only proven care –
not costs – drives health decisions.
• Patients are acknowledged as partners in their care
and are therefore well-informed and well-treated. This better
medicine, more responsible medicine means better health
and wellness for patients, creating greater value for everyone.
13) I hear so much about this so-called "evidence-based
medicine." What is that? That seems like an excuse
to keep from prescribing antibiotics when I have a sinus
infection.
•
“Evidence-based medicine is the conscientious, explicit,
and judicious use of current best evidence in making decisions
about the care of individual patients.” (British Medical
Journal, 1996; 312:71-72 (13 January))
• Its practice is an integration of an individual doctor’s
expertise with the best available clinical evidence.
• It is not a sacrifice of a doctor’s autonomy
to external rules. In fact, by combining a doctor’s
experience and intuition with clinical research, it means
that diagnosis and treatment are made more effective and
efficient while remaining patient-centric.
• Clinical evidence replaces invalidated treatments
with new ones that are more accurate and therefore safer.
• Evidence-based medicine will not keep your doctor
from prescribing antibiotics for your sinus infection because
there is no clinical evidence that this practice is inferior
to another treatment. If a better treatment is found that
does not use antibiotics, then hopefully you too would no
longer want your doctor to prescribe you an outmoded therapy.
14) I benefit a lot from going to my nutritionist, my yoga
teacher, my masseuse, and my kabalist -- how does the care
they give me (which makes me feel a lot better than the
care I get from my doctor) fit in with the coordinated care
that Accountable Physician Practices offer?
•
While the care you receive from these individuals may benefit
your mind, body, and spirit and make you feel great, in
the end, these practitioners are not doctors and are not
trained to address serious illness.
• However, they do have something in common with the
doctors who strive to provide coordinated care in that they
are concerned with more than an individual’s symptoms.
Doctors of multispecialty medical groups believe that each
patient is more than a series of symptoms. Each patient
is a whole body whose treatment requires the integration
of specialist doctors.
• Doctors working in multispecialty medical groups
or Accountable Physician Practices may not offer you Swedish
massage or meditative breathing, but they will understand
how these practices are an important part of your life and
applaud your extra effort to take good care of yourself.
15) If this is so great, why isn't everyone running to put
this in place everywhere?
•
In fact, you may be surprised to know that multispecialty
medical groups are more common than you think. Accountable
Physician Practices are present in nearly every single state
in the country.
• The concept is not a new one, but because of growing
consumer dissatisfaction with the status quo, multispecialty
medical groups are getting more attention and gaining momentum. |
©
2008 Council of Accountable Physician Practices. CAPP is a 501(c)(6)
organization affiliated with AMGA’s 501(c)(3) foundation.
Updated 07/23/2008.