Any practice that has sought recognition as a PCMH can tell you that it’s a commitment of time and money. With fewer resources to rely on, smaller practices, in particular, may decide that the payoff isn’t worth the price. But small and solo practices are just as capable of delivering value-based, patient-centered care. Here, consultants and PCMH team members share their secrets for small-practice PCMH success.
Go PCMH Big or Go Home
Full commitment is essential. “Practice leadership needs an initial meeting to ask ‘why are we going through this process and what do we believe will help the patient?’” says Mark Frazer, a physician with Summit Family Physicians, a level-three recognized PCMH in Middletown, Ohio.
Doing this also means educating your staff. “You’re asking your employees to work harder, work smarter and do more than they’ve ever done before,” says Frazer. “If you don’t have buy-in or acceptance, you’re going to have an uphill battle.”
Empower Your Staff
All staff members play an important role in team-based care, especially at a solo or small practice. “Every person has the ability to impact patient care,” says Frazer, who encourages his team to brainstorm ways to serve patients better, test those techniques and report back. “Everyone is empowered to become experts in their area. I’m amazed at how little push-back we’ve received. Our employee satisfaction surveys are much higher.”
Choose a Point Person
Practices should designate a point person to ensure that PCMH targets remain on track. Accountability is key, says John Ruiz, a consultant for FQHC Associates in Wilmington, Delaware. “Providers and staff are busy seeing patients and carrying on with their job responsibilities,” he says, suggesting that a “champion” be identified to move the process forward. In smaller practices, that’s often the clinical coordinator (e.g., a nurse practitioner), who is well-positioned to manage team-based care.
Even small, resource-challenged practices can achieve PCMH recognition. Lloyd Van Winkle, a primary care physician and American Academy of Family Physicians (AAFP) board member, created his own PCMH support network by working with other small practices in his area. Each practice took one item on the PCMH checklist (e.g., care coordination, patient engagement, population management), conducted research on the work needed to meet the requirement, developed a strategy to achieve it and shared it with the group.
Consider Hospital Hospitality
Managing patients effectively means having access to hospital discharge records. It’s imperative that practices cultivate a positive working relationship with local hospital staff, says Laura Palmer, senior fellow for MGMA. “You need to meet routinely with the hospital and have conversations about any problem cases that come up.”
Use Your Payers
Large practices have the resources to retain a health coach or case manager, but small practices might be stretched financially. To close the gap and ensure that staff members don’t feel overburdened, Palmer suggests reaching out to third-party payers. Many offer free programs to help manage patients with chronic illness— making phone calls to initiate follow-ups, sending appointment reminder e-mails and texting prescription refill reminders.