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