| For many of us change is a difficult process. | | | | provide an example using the Medicare |
| In organizations like healthcare it seems to | | | | program. A patient who enters the Medicare |
| advance at a snail's pace sometimes. There is | | | | program is entitled to a paid initial |
| a need for change in healthcare, most agree, | | | | physical. A primary care physician should |
| though we would be hard pressed to agree upon | | | | take advantage of this. Many don't. If I were |
| the changes needed. One incentive for change | | | | the manager of such an office, I would remind |
| is pay-for-performance programs now beginning | | | | my staff who set up appointments to be aware |
| in several areas. I would like to describe a | | | | of this fact. I would remind them at regular |
| couple that affect primary care physicians | | | | staff meetings. I would post visible |
| and then give a few suggestions as to how to | | | | reminders in the office. I might even have a |
| adopt changes to take advantage of these | | | | message flashed on the computer screen once |
| programs. Even if you are not in a primary | | | | in a while. Then I would review the |
| care physician program, the methods suggested | | | | appointments of patients who have become |
| for change will be helpful, I believe. | | | | Medicare qualified and see how many had their |
| | | | initial physical or were booked for it. I |
| In 2006 Medicare plans to institute a | | | | would adjust my methods to remind staff of |
| pay-for-performance program at the primary | | | | the need for such examinations and continue |
| care physician level. Right now a model is | | | | to improve on this until the office achieves |
| being tested and seems to be doing quite | | | | 100% compliance with the goal. |
| well. In several states Blue Cross Blue | | | | |
| Shield organizations are testing pay-for- | | | | Booking the exam is not the only needed |
| performance programs. Here in West Michigan, | | | | change. Doctors who perform the physical must |
| Priority Health, a healthcare insurer, has | | | | accomplish examination details and actions |
| promoted such a program for over five years. | | | | laid out by Medicare. Hence, to be paid for |
| How does this work, you may ask? Priority | | | | the exam, each doctor must adhere to the exam |
| Health, for example, funds the program for | | | | details. I would help the doctors accomplish |
| each of its patients a set amount. Doctors | | | | this in a variety of ways, depending on the |
| who meet a requirement of the program for a | | | | doctor's learning style. For example, a |
| patient are rewarded with extra money for | | | | checklist of the exam details might be |
| that patient. Hence, with many patients the | | | | included in the patient history folder when |
| income for the practice can be boosted | | | | the exam is performed. That way the doctor |
| considerably. The fact is that many are not | | | | will not miss any steps. As the leader of the |
| rising to the opportunity. With planned cuts | | | | change, I would check with billing to see |
| in Medicare reimbursements over the next few | | | | that all the steps were performed and adapt |
| years, this source of income cannot be | | | | new approaches or reinforce existing ones to |
| ignored! Healthcare programs need to change, | | | | see that the changes are accomplished 100% of |
| no matter how difficult. | | | | the time. |
| | | | |
| The impetus for change should rest with the | | | | Changes such as these should be a part of a |
| leadership of an organization, although the | | | | continuous quality improvement program at |
| change should not be the sole responsibility | | | | every healthcare provider organization. Let |
| of the leaders. Representatives from all | | | | me quickly review the most important steps. |
| parts of the organization should be involved. | | | | First leaders should identify the changes |
| Once the need for change in a process is | | | | needed. Then, the leaders should convene a |
| agreed upon, either because of extra revenue | | | | committee of all affected staff to develop |
| from pay-for-performance programs or other | | | | how to accomplish the change. Once the staff |
| agents or data that positively affect the | | | | agrees upon the approach, the leaders should |
| bottom line, leaders should convene a task | | | | develop ways to implement the change on a |
| force to plan the change. With input from | | | | daily basis adopting methods that incorporate |
| all, leaders should map the process as it | | | | learning styles of affected individuals. |
| currently exits and then should make a new | | | | Then, they should continually analyze the |
| map of how they would like it to be to | | | | progress of the changes and make necessary |
| incorporate the positive changes. The new | | | | adjustments until the goals are accomplished. |
| procedure should be standardized for all to | | | | They should then audit the changes |
| adopt. | | | | occasionally to be sure that the organization |
| | | | doesn't fall back into old habits. |
| How do you go about adopting these changes on | | | | |
| a daily basis? This is probably the hardest | | | | I believe that adopting such a change process |
| part. Because humans learn in a variety of | | | | will dramatically help at your site. You will |
| ways, it will take a variety of ways to | | | | see savings in time, increased patient or |
| implement the changes. The implementation of | | | | client health and satisfaction, as well as an |
| the changes should be based upon the learning | | | | improved bottom line! |
| styles of the individuals involved. Let me | | | | |