Re: secure scheduling --one more followup

[Guest guest]

I have no interest in these guys and doubt I have use for their services... but I emailed them about the fact that they have the secure messaging  I am doing an admin day and training my new nurse and was lookin around at alot   of stuff today, thinkin about my systems an d  so forth ,  looking at  hippa secure cloud file sharing  stuff(me? who knew?)  so..

 I noted that  they seem to offer the scheduling only with their websites which seem  very pricey, but did get this below  --anyway just passin it along.  Maybe they can flex.We’re

big fans of the IMP model and are always looking for ways to support what you’re doing. . If

any IMP members need any help getting signed up, even if just for our free basic profile service, let me know and I, or someone on my team, would be happy to assist. Regards,Andrei

Andrei ZimilesDoctor.com | Connecting You With Care

Jean

   Hi  I do not even USE this stuff but you guys have been talking about thisand then  I got this thing from Doctor.com which I think Gordon was talkin about and

voila: they say:Yes,

our solution is HIPAA-compliant to the extent that we will sign a Business Associate agreement with your practice and that it’s built using bank-grade 256-bit SSL security and healthcare security best practices. We absolutely do not display any information publicly

about patient visits or which doctors a patient sees. Any visit-related

information is visible only to you, authorized members of your staff, and the patient him/herself.Of course, as with any solution, Doctor.com’s platform is only as secure or compliant as its users, so your staff will need to be certain that they are properly handing patient’s PHI (Personal Health Information) and using the message features of our platform properly.-- Jean     MD          ph    fax

--      MD          ph    fax

[Guest guest]

you are getting a NURSE?!?!?! Wow! I hope it works out great for you. You

deserve it!---Sharlene

>

> > Hi

> >

> > I do not even USE this stuff but you guys have been talking about this

> > and then

> > I got this thing from Doctor.com which I think Gordon was talkin about and

> > voila: they say:

> > Y*es, our solution is HIPAA-compliant to the extent that we will sign a

> > Business Associate agreement with your practice and that it's built using

> > bank-grade 256-bit SSL security and healthcare security best practices.

> >

> > We absolutely do not display any information publicly about patient visits

> > or which doctors a patient sees. Any visit-related information is visible

> > only to you, authorized members of your staff, and the patient him/herself.

> >

> > Of course, as with any solution, Doctor.com's platform is only as secure

> > or compliant as its users, so your staff will need to be certain that they

> > are properly handing patient's PHI (Personal Health Information) and using

> > the message features of our platform properly.

> > *

> > -- Jean

> >

> >

> >

> > MD

> >

> >

> > ph fax

> >

> >

>

>

>

> --

>

>

>

> MD

>

>

> ph fax

>

>

[Guest guest]

great job jean. what a great idea.

you can outsource me too for shakin the pompoms!!!

no fee required!

cheers.

g

> >

> > >

> > > > Hi

> > > >

> > > > I do not even USE this stuff but you guys have been talking about this

> > > > and then

> > > > I got this thing from Doctor.com which I think Gordon was talkin about

> > and

> > > > voila: they say:

> > > > Y*es, our solution is HIPAA-compliant to the extent that we will sign a

> >

> > > > Business Associate agreement with your practice and that it's built

> > using

> > > > bank-grade 256-bit SSL security and healthcare security best practices.

> > > >

> > > > We absolutely do not display any information publicly about patient

> > visits

> > > > or which doctors a patient sees. Any visit-related information is

> > visible

> > > > only to you, authorized members of your staff, and the patient

> > him/herself.

> > > >

> > > > Of course, as with any solution, Doctor.com's platform is only as

> > secure

> > > > or compliant as its users, so your staff will need to be certain that

> > they

> > > > are properly handing patient's PHI (Personal Health Information) and

> > using

> > > > the message features of our platform properly.

> > > > *

> > > > -- Jean

> > > >

> > > >

> > > >

> > > > MD

> > > >

> > > >

> > > > ph fax

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > >

> > >

> > >

> > > MD

> > >

> > >

> > > ph fax

> > >

> > >

> >

> >

> >

>

>

>

> --

>

>

>

> MD

>

>

> ph fax

>

>

[Guest guest]

That sounds fascinating. Could you explain more please?

What are the places you were told to call? (when you say " called the places he

said and i got a grant of 5,000. " )

P.J.

> >

> > >

> > > > Hi

> > > >

> > > > I do not even USE this stuff but you guys have been talking about this

> > > > and then

> > > > I got this thing from Doctor.com which I think Gordon was talkin about

> > and

> > > > voila: they say:

> > > > Y*es, our solution is HIPAA-compliant to the extent that we will sign a

> >

> > > > Business Associate agreement with your practice and that it's built

> > using

> > > > bank-grade 256-bit SSL security and healthcare security best practices.

> > > >

> > > > We absolutely do not display any information publicly about patient

> > visits

> > > > or which doctors a patient sees. Any visit-related information is

> > visible

> > > > only to you, authorized members of your staff, and the patient

> > him/herself.

> > > >

> > > > Of course, as with any solution, Doctor.com's platform is only as

> > secure

> > > > or compliant as its users, so your staff will need to be certain that

> > they

> > > > are properly handing patient's PHI (Personal Health Information) and

> > using

> > > > the message features of our platform properly.

> > > > *

> > > > -- Jean

> > > >

> > > >

> > > >

> > > > MD

> > > >

> > > >

> > > > ph fax

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > >

> > >

> > >

> > > MD

> > >

> > >

> > > ph fax

> > >

> > >

> >

> >

> >

>

>

>

> --

>

>

>

> MD

>

>

> ph fax

>

>

[Guest guest]

so ,as we knowI am not normal like the rest of you I am  weird and insnae  I do not  have a good IPA or great payors or a population that is plentiful with good payors..I have a lot of stuff I am up agianst So driving home one night  I decided that I d o good work and  I should get a grant to do more good work becasue noone else was going ot  jump out and give me money...

 so I called up a guy I know. Lawyer. Runs Consumers for affordable Health care here  in MAine One thing about being an IMP is that over the  7 yrs I have been dumb enough to do this I have met all sorts of folks So Joe  he is always wanting me to contribute to Consumers for affordable Health Care.  I have no $!! BUT he runs off grants and we mutually think  the other of us does cool work

so I call him and say Joe where can I get money?And he tells me three foundations that fund Maine projects esp health care the first said no not for  us The second said sure  fill out this  form(that took me weeks to write it and type it) and after I submitted it, becasue the phone call had been required and was the  most important part, it took 36 hrs to  be told yes you get $5,000.   and so I never needed the third place

So who do you know who can tell you about grants in your neck of the woods?? then you write one up I would tell you more but typing is painful see below  is what I wrote I got the money from the BIngham Program but they are MAine based so you have to  look locally...I figure I can do a little l good and they will not know I am insane til the 5,000 is gone:)

somewhat seriously...  it was buying a laptop  setting up the IT  buying a user emr licnese and finding the time to teach the nurse that were the barriers , that a small grant got me over the hump for Eventually  only I will pay her salary  but that is not much. I try ot pay her well  She got out of rn school 1 yr ago  and the hospital hired her at 16.oo/hr!!

I have  two experience IMP nurses who are  training  Sara  in problem solving and coaching--- over Skype:) So  all o  f us  in IMP are  great resources  for each  otherCome to IMP camp in  October we can talk more and  I will see if I  have gotten anywhere.

Her e  is what I wrote You are welcome to steal it for a small fee:

 

What problems, needs, or

issues does your proposal address?

 

In primary care a key task is to

coordinate care. This is difficult to do in the current environment, outside of

the rare topnotch integrated systems. One definition of coordination is to shepherd

patients across silos of various services and providers; prevent errors and

repeated tests; identify and share patients’ needs and preferences; and avoid conflicting

plans of care. There is little infrastructure in place to do this. Patients

interact with both primary care and specialist physicians, and pharmacists, nutritionists,

and PT/OT etc as well.

There are few clear protocols and

expectations around shared care.

Visits are unnecessarily lengthened,

errors occur, adverse reactions and morbidity are increased, and increased

costs occur by addressing coordination in the current piecemeal, reactionary manner.

 

Describe the program or

project for which you seek funding, why you decided to pursue this project and

whether it is a new or on-going part of your organization.

The goal is to design a new program

to establish protocols to facilitate communication, and to align efforts to improve

the care provided by a population of providers outside of an employer network. This

entails designing the program, doing outreach to providers, and hiring staff.

Staff time would be an RN two hrs a week - working late afternoon or evening on

the day I am not in the office. This design increases access to my practice,

and keeps my costs—overhead--low, as no additional work space is needed for the

new staff member.

Funding is sought to establish a

program which will facilitate ongoing collaboration and care coordination among

practices that care for the same population of patients. Practices currently

work in silos of processes, EMRs, faxes, phones, staffing and office hrs. In addition

to reducing the burden that current care processes place on patients, having improved

processes enables me to do my job better and more efficiently and, frankly,

with greater satisfaction. The goal is to do outreach to establish a network of

interested committed providers, and to establish processes, then follow-up with

re -designed office flow and measurable goals for care coordination.

 

What are the goals, objectives

and activities/strategies involved in this proposal? A timeline is often

helpful to describe your work over time.

The first goal is time

consuming-- to hire and train a staff member. Estimate 6-24 wks based on a previous

training and the need to set up the tech infrastructure. This person will be an

RN to have the necessary skill set.

The next goal is to develop

a system to coordinate care, beginning with outreach to a set of shared care

providers to determine access, communication, feedback and other methods to

coordinate care among all of us. We might have something basic in place inside of

two months, but it will take a year or longer to flesh out the process.

The third goal is long term --perhaps

1 to 5 yrs—to assess and fine tune our work and the ability to measure it,

 

Possibilities for communication

include Doximity, or Updox, as they are secure, or email, or some variety of cloud

computing. It maybe that we re-institute something this community began and

dropped- a consistent hand held paper patient portable record. It may be that

we provide patients and families –who are after all the one link across silos,

with a kit to facilitate coordination and medication safety. There are several

ideas brewing about the specifics.

All of these methods have

drawbacks and advantages. Hippa is a barrier, as is the commitment of the

providers involved.

 

 

Describe the significance

of your project:  How will it achieve systemic change? Does it introduce a

new service or program? Will it serve as a model program for other

organizations or communities? How does your program fit into the funding

priorities of The Bingham Program?

This project extends primary care to

its fullest. In addition, I enhance practice capacity and therefore access to

primary care.

Patients are not isolated

patients of my practice but engage with hospitals, pharmacists, specialists, dietitians

etc. Without coordination patients suffer adverse effects or, at best, missed

opportunities for care.

Most primary care practices, of

necessity, put their resources into putting out fires. Establishing a clear

plan is cutting edge. This overlaps the intent of the work ACOs are to do but

those are complex medico- legal organizations, which are based on financial

risk and are inaccessible to any one local practice that wants to move forward.

This project should be replicable. Other

practices may already have staff and user licenses etc., so if a program is

described and tested, it should be possible for practices to replicate this

work. Those practices that have some overlap in the same specialist use as my

practice will find it especially easy

This project aligns with The Bingham

Program’s interest in improved service delivery models.

 

 

What are the positive

assets of your organization or community that lead you to believe you can

address these problems effectively?

 This

is already an innovative practice. I currently have no in office staff .Structured

,at my own expense of lowered income, to leverage technology and thus to lower

overhead, I have superb access and continuity , and have spent seven  years building a practice that improves and measures  access and outcomes.

The 501c3 I work with --Ideal Medical Practices,

impcenter.org-- was born out of the recognition that solo and small practices

are capable of delivering high quality care but struggle with obstacles such as

lack of financing. Ideal

Medical Practices provides me with support from a nationwide array of folks in similar

innovative practices, and also the resources of folks trained in QI work at Dartmouth

and formerly with the IHI.

In

this practice I

have already gotten one payer to fund me differently-globally --away from fee for

service-- due to the quality work I do. I have presented at IHI, AAFP, Ideal

Medical Practices, and been published in FPM. This project supports

the new model of care delivery I have been crafting since opening in June 2005.

 

 

Do you have plans for

evaluating the success of your project? Who will conduct the evaluation? How

will you use and disseminate the results of the evaluation?

The goal is to create a report card

of measures:

While there are many published

measures of care coordination (references/bibliography available), most are

limited by being disease metric focused .My goal is to measure more globally.

Measures are still in flux but include the following:

 

A.   

Follow up to consultations / service

utilization.  I already have a

rudimentary protocol in place to follow up with patients. I would expand and

standardize this, and also follow the processes with the outside consultants as

to quality of communication and appropriateness of consultation.

B.    

Access   Often

it is hard to get appointment making done  

-- how easy it is to both get an appointment with specialists and how long

the wait time is can be tracked.

C.    

Communication   Med lists are already given to every patient

but over time I expect that the med lists in specialists’ notes will match up

better. This can be tracked.

D.  Provider satisfaction- reported

E. 

Reorganize my office flow with a nurse identifying and initiating care coordination

for identified patients.

F.  Continue with current monitoring through the

tool HowsYourHealth as to preventable ER and hospitalizations.

 

 

 

How will your program or

project continue after Bingham Program funding ends? Who will help sustain

critical program activities?

Without assistance my lone

practice’s bootstrapping efforts are inadequate to finance the onetime costs

that overcome the hurdles for the initial set up. I need assistance for the

time to plan and do the outreach as well as to train one part time staffer that

will shoulder this workload.

 

Once the nurse is trained and protocols are established, I will

not need to take time away from seeing patients (income producing time), and I anticipate

that I can see a few more patients per week due to the nurse’s skill set. This

will generate the funds to sustain the program. Nurses can also bill for “incident

to services “from few payers, or can provide services such as a strep test that

will allow me to bill for evisits while she is present and I am off site- and

if she can meet a goal of billing one visit at each of her weekly two hr work

sessions, that covers her salary.

The problem is to come up with the funding for the initial

breathing room. The money I am requesting is basically month’s income.  In primary care in Maine, in the Western Mountains,

my payor mix is about 60% Medicare and Medicaid. I have little reserve .This

grant does cover salary indirectly- mine and the nurse’s while we train. See attached

budget. Grant funding does cover two capitol expenses- a laptop for the nurse and

IT to set up the network. I cannot do this on my own without taking on personal

debt. This program will extend the practice and support a new program that will

be ongoing for the life of the practice.

 

 

That sounds fascinating. Could you explain more please?

What are the places you were told to call? (when you say " called the places he said and i got a grant of 5,000. " )

P.J.

> >

> > >

> > > > Hi

> > > >

> > > > I do not even USE this stuff but you guys have been talking about this

> > > > and then

> > > > I got this thing from Doctor.com which I think Gordon was talkin about

> > and

> > > > voila: they say:

> > > > Y*es, our solution is HIPAA-compliant to the extent that we will sign a

> >

> > > > Business Associate agreement with your practice and that it's built

> > using

> > > > bank-grade 256-bit SSL security and healthcare security best practices.

> > > >

> > > > We absolutely do not display any information publicly about patient

> > visits

> > > > or which doctors a patient sees. Any visit-related information is

> > visible

> > > > only to you, authorized members of your staff, and the patient

> > him/herself.

> > > >

> > > > Of course, as with any solution, Doctor.com's platform is only as

> > secure

> > > > or compliant as its users, so your staff will need to be certain that

> > they

> > > > are properly handing patient's PHI (Personal Health Information) and

> > using

> > > > the message features of our platform properly.

> > > > *

> > > > -- Jean

> > > >

> > > >

> > > >

> > > > MD

> > > >

> > > >

> > > > ph fax

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > >

> > >

> > >

> > > MD

> > >

> > >

> > > ph fax

> > >

> > >

> >

> >

> >

>

>

>

> --

>

>

>

> MD

>

>

> ph fax

>

>

--      MD          ph    fax

[Guest guest]

Really neat Jean!!!

To: Sent: Wednesday, June 20, 2012 8:32:12 AMSubject: Re: Re: secure scheduling --one more followup

I didn't get a regular office nurse I decided I wanted someone other than me to work on care coordination with other docs and med reconciliation and to teach pateitns. Everyone knows nurses do that stuff better I have no space or money or need for a regular nurse although I guess it could be good, anyway so I decided someone should give me money(!) and I called up someone and asked how, and then called the places he said and i got a grant of 5,000. IT was tres easy! This buys the EMR user license and a laptop and sometime to trai n her She will be in my space on Wednesdays when I am not theer so while I cannot bill for her time but she can do work I can turf to her and wil lnot cost that much. Just 2 hrs on Wed afternnon for the strep tests I tha talwasy are needed when I am off and soon We will see.Now here is the power of IMP somewhat- individuals do not get grants easily. I needed a 5013c to hold the money There are organizations who do that but IMP is a 501 3c so I asked the exec bd who asked the bd who said yes this fits with our mission and I give $250.00 as a donation to IMP for holding the money and the treas will dole it out to me as I invoice.I have Bradys nurse educator teaching her and JUdy Zettek Gordons old nurse teaching about tproblem solving (I pay them Judy did skype)She currently works at a hospital peds "factory office" and hatesit.She is an RN we will see AT least it amuses me away form the usual stuff:)JEan

you are getting a NURSE?!?!?! Wow! I hope it works out great for you. You deserve it!---Sharlene

> > > Hi> >> > I do not even USE this stuff but you guys have been talking about this> > and then> > I got this thing from Doctor.com which I think Gordon was talkin about and> > voila: they say:> > Y*es, our solution is HIPAA-compliant to the extent that we will sign a > > Business Associate agreement with your practice and that it's built using> > bank-grade 256-bit SSL security and healthcare security best practices.> >> > We absolutely do not display any information publicly about patient visits> > or which doctors a patient sees. Any visit-related information is visible> > only to you, authorized members of your staff, and the patient him/herself.> >> > Of course, as with any solution, Doctor.com's platform is only as secure> > or compliant as its users, so your staff will need to be certain that they> > are properly handing patient's PHI (Personal Health Information) and using> > the message features of our platform properly.> > *> > -- Jean> >> >> >> > MD> > > > > > ph fax > > > >> > > > -- > > > > MD> > > ph fax > >

-- MD ph fax

[Guest guest]

et al -

great, thanks for the explanation, I enjoyed reading your writeup...

I started www.ardasclinic.com 4.5 months ago (6 mo p/residency) with the goal of

serving Denver's refugees. I have 1 staff (check in, blood draws, shots), and we

see 60% MCD + 20% Uninsured ($45 self pay fee if they have it, or free if they

look poor enough) + 20% MCR or insured; ...or about 80% refugees (half arrivals

within last few years eg Burmese Nepali, and half more established eg Somali

Ethiopian Eritrean) + 20% nonrefugee (eg they found us on their blue cross plan

or referred by local ERs). In 4 months we have gone from zero to about 11 a day

average now (yesterday 17!), which, after expenses, pays me as much as any local

FP at Kaiser. We are the only private (for profit LLC) on

http://www.clinicnet.org/index.php?s=9488, the state association of low income

clinics. The rest are big hospital systems (FQHCs getting grant$), nonprofits,

or religious charities. We are proving one can do underserved medicine and still

make $, thanks to the efficiencies and better care realized by the IMP concept.

Still, I have considered getting grants, like you have. We can't get the local

grant ( " Primary Care Fund " ), because we haven't been open 1 year, we can't get

18k for meaningless use because the attestation period has to be in calendar

year 2011 (we opened in 2012), and I can't get loan repayment (you have to be a

nonprofit to become a HPSA). There are other local grants, similar to the one

you mention, but I always wonder if the time is worth it ($/hr spent applying)

vs just seeing more patients with that time. It seems one could spend forever on

grant writing, then grant reporting, additional record keeping, etc...

One of these years I will make it to the camp and meet some of you other insane

types...

P.J.

> > > >

> > > > >

> > > > > > Hi

> > > > > >

> > > > > > I do not even USE this stuff but you guys have been talking about

> > this

> > > > > > and then

> > > > > > I got this thing from Doctor.com which I think Gordon was talkin

> > about

> > > > and

> > > > > > voila: they say:

> > > > > > Y*es, our solution is HIPAA-compliant to the extent that we will

> > sign a

> > > >

> > > > > > Business Associate agreement with your practice and that it's built

> > > > using

> > > > > > bank-grade 256-bit SSL security and healthcare security best

> > practices.

> > > > > >

> > > > > > We absolutely do not display any information publicly about patient

> > > > visits

> > > > > > or which doctors a patient sees. Any visit-related information is

> > > > visible

> > > > > > only to you, authorized members of your staff, and the patient

> > > > him/herself.

> > > > > >

> > > > > > Of course, as with any solution, Doctor.com's platform is only as

> > > > secure

> > > > > > or compliant as its users, so your staff will need to be certain

> > that

> > > > they

> > > > > > are properly handing patient's PHI (Personal Health Information)

> > and

> > > > using

> > > > > > the message features of our platform properly.

> > > > > > *

> > > > > > -- Jean

> > > > > >

> > > > > >

> > > > > >

> > > > > > MD

> > > > > >

> > > > > >

> > > > > > ph fax

> > > > > >

> > > > > >

> > > > >

> > > > >

> > > > >

> > > > > --

> > > > >

> > > > >

> > > > >

> > > > > MD

> > > > >

> > > > >

> > > > > ph fax

> > > > >

> > > > >

> > > >

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > >

> > >

> > >

> > > MD

> > >

> > >

> > > ph fax

> > >

> > >

> >

> >

> >

>

>

>

> --

>

>

>

> MD

>

>

> ph fax

>

>

[Guest guest]

PJ,You should be able to attest for 2012 if it is your first year attesting for only 90 days....that is my understanding from CMS.  Year 1 of the attestation means the first year that you attest, not the first year the program was open...

Good luck with your new practice! Pratt

 

et al -

great, thanks for the explanation, I enjoyed reading your writeup...

I started www.ardasclinic.com 4.5 months ago (6 mo p/residency) with the goal of serving Denver's refugees. I have 1 staff (check in, blood draws, shots), and we see 60% MCD + 20% Uninsured ($45 self pay fee if they have it, or free if they look poor enough) + 20% MCR or insured; ...or about 80% refugees (half arrivals within last few years eg Burmese Nepali, and half more established eg Somali Ethiopian Eritrean) + 20% nonrefugee (eg they found us on their blue cross plan or referred by local ERs). In 4 months we have gone from zero to about 11 a day average now (yesterday 17!), which, after expenses, pays me as much as any local FP at Kaiser. We are the only private (for profit LLC) on http://www.clinicnet.org/index.php?s=9488, the state association of low income clinics. The rest are big hospital systems (FQHCs getting grant$), nonprofits, or religious charities. We are proving one can do underserved medicine and still make $, thanks to the efficiencies and better care realized by the IMP concept.

Still, I have considered getting grants, like you have. We can't get the local grant ( " Primary Care Fund " ), because we haven't been open 1 year, we can't get 18k for meaningless use because the attestation period has to be in calendar year 2011 (we opened in 2012), and I can't get loan repayment (you have to be a nonprofit to become a HPSA). There are other local grants, similar to the one you mention, but I always wonder if the time is worth it ($/hr spent applying) vs just seeing more patients with that time. It seems one could spend forever on grant writing, then grant reporting, additional record keeping, etc...

One of these years I will make it to the camp and meet some of you other insane types...

P.J.

> > > >

> > > > >

> > > > > > Hi

> > > > > >

> > > > > > I do not even USE this stuff but you guys have been talking about

> > this

> > > > > > and then

> > > > > > I got this thing from Doctor.com which I think Gordon was talkin

> > about

> > > > and

> > > > > > voila: they say:

> > > > > > Y*es, our solution is HIPAA-compliant to the extent that we will

> > sign a

> > > >

> > > > > > Business Associate agreement with your practice and that it's built

> > > > using

> > > > > > bank-grade 256-bit SSL security and healthcare security best

> > practices.

> > > > > >

> > > > > > We absolutely do not display any information publicly about patient

> > > > visits

> > > > > > or which doctors a patient sees. Any visit-related information is

> > > > visible

> > > > > > only to you, authorized members of your staff, and the patient

> > > > him/herself.

> > > > > >

> > > > > > Of course, as with any solution, Doctor.com's platform is only as

> > > > secure

> > > > > > or compliant as its users, so your staff will need to be certain

> > that

> > > > they

> > > > > > are properly handing patient's PHI (Personal Health Information)

> > and

> > > > using

> > > > > > the message features of our platform properly.

> > > > > > *

> > > > > > -- Jean

> > > > > >

> > > > > >

> > > > > >

> > > > > > MD

> > > > > >

> > > > > >

> > > > > > ph fax

> > > > > >

> > > > > >

> > > > >

> > > > >

> > > > >

> > > > > --

> > > > >

> > > > >

> > > > >

> > > > > MD

> > > > >

> > > > >

> > > > > ph fax

> > > > >

> > > > >

> > > >

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > >

> > >

> > >

> > > MD

> > >

> > >

> > > ph fax

> > >

> > >

> >

> >

> >

>

>

>

> --

>

>

>

> MD

>

>

> ph fax

>

>

[Guest guest]

Very interesting stuff I have some  ideas that Colorado is doing some very intersting work around PCMH and its medciiaid..Have you talke ot Gorodn? or to  Greg Sharp in woodland p[ark who I think jas moved intosome other intersting posotion ..? OR I cannot imagine there are not palces wher eyou can access philanthropic foundations to get a simple grant as I did- you need a contact.

emailme offlist maybe  and I can look up Greg;s emailor we can ask G -if he is not here lsitennin  maybe g-- what he knows  as he is in Colorado alot  Very inteertsing woprk you doong. 

 

PJ,You should be able to attest for 2012 if it is your first year attesting for only 90 days....that is my understanding from CMS.  Year 1 of the attestation means the first year that you attest, not the first year the program was open...

Good luck with your new practice! Pratt

 

et al -

great, thanks for the explanation, I enjoyed reading your writeup...

I started www.ardasclinic.com 4.5 months ago (6 mo p/residency) with the goal of serving Denver's refugees. I have 1 staff (check in, blood draws, shots), and we see 60% MCD + 20% Uninsured ($45 self pay fee if they have it, or free if they look poor enough) + 20% MCR or insured; ...or about 80% refugees (half arrivals within last few years eg Burmese Nepali, and half more established eg Somali Ethiopian Eritrean) + 20% nonrefugee (eg they found us on their blue cross plan or referred by local ERs). In 4 months we have gone from zero to about 11 a day average now (yesterday 17!), which, after expenses, pays me as much as any local FP at Kaiser. We are the only private (for profit LLC) on http://www.clinicnet.org/index.php?s=9488, the state association of low income clinics. The rest are big hospital systems (FQHCs getting grant$), nonprofits, or religious charities. We are proving one can do underserved medicine and still make $, thanks to the efficiencies and better care realized by the IMP concept.

Still, I have considered getting grants, like you have. We can't get the local grant ( " Primary Care Fund " ), because we haven't been open 1 year, we can't get 18k for meaningless use because the attestation period has to be in calendar year 2011 (we opened in 2012), and I can't get loan repayment (you have to be a nonprofit to become a HPSA). There are other local grants, similar to the one you mention, but I always wonder if the time is worth it ($/hr spent applying) vs just seeing more patients with that time. It seems one could spend forever on grant writing, then grant reporting, additional record keeping, etc...

One of these years I will make it to the camp and meet some of you other insane types...

P.J.

> > > >

> > > > >

> > > > > > Hi

> > > > > >

> > > > > > I do not even USE this stuff but you guys have been talking about

> > this

> > > > > > and then

> > > > > > I got this thing from Doctor.com which I think Gordon was talkin

> > about

> > > > and

> > > > > > voila: they say:

> > > > > > Y*es, our solution is HIPAA-compliant to the extent that we will

> > sign a

> > > >

> > > > > > Business Associate agreement with your practice and that it's built

> > > > using

> > > > > > bank-grade 256-bit SSL security and healthcare security best

> > practices.

> > > > > >

> > > > > > We absolutely do not display any information publicly about patient

> > > > visits

> > > > > > or which doctors a patient sees. Any visit-related information is

> > > > visible

> > > > > > only to you, authorized members of your staff, and the patient

> > > > him/herself.

> > > > > >

> > > > > > Of course, as with any solution, Doctor.com's platform is only as

> > > > secure

> > > > > > or compliant as its users, so your staff will need to be certain

> > that

> > > > they

> > > > > > are properly handing patient's PHI (Personal Health Information)

> > and

> > > > using

> > > > > > the message features of our platform properly.

> > > > > > *

> > > > > > -- Jean

> > > > > >

> > > > > >

> > > > > >

> > > > > > MD

> > > > > >

> > > > > >

> > > > > > ph fax

> > > > > >

> > > > > >

> > > > >

> > > > >

> > > > >

> > > > > --

> > > > >

> > > > >

> > > > >

> > > > > MD

> > > > >

> > > > >

> > > > > ph fax

> > > > >

> > > > >

> > > >

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > >

> > >

> > >

> > > MD

> > >

> > >

> > > ph fax

> > >

> > >

> >

> >

> >

>

>

>

> --

>

>

>

> MD

>

>

> ph fax

>

>

--      MD          ph    fax

[Guest guest]

Amazing work, PJ.Frederick Elliott MDBuffalo, NY

et al -

great, thanks for the explanation, I enjoyed reading your writeup...

I started www.ardasclinic.com 4.5 months ago (6 mo p/residency) with the goal of serving Denver's refugees. I have 1 staff (check in, blood draws, shots), and we see 60% MCD + 20% Uninsured ($45 self pay fee if they have it, or free if they look poor enough) + 20% MCR or insured; ...or about 80% refugees (half arrivals within last few years eg Burmese Nepali, and half more established eg Somali Ethiopian Eritrean) + 20% nonrefugee (eg they found us on their blue cross plan or referred by local ERs). In 4 months we have gone from zero to about 11 a day average now (yesterday 17!), which, after expenses, pays me as much as any local FP at Kaiser. We are the only private (for profit LLC) on http://www.clinicnet.org/index.php?s=9488, the state association of low income clinics. The rest are big hospital systems (FQHCs getting grant$), nonprofits, or religious charities. We are proving one can do underserved medicine and still make $, thanks to the efficiencies and better care realized by the IMP concept.

Still, I have considered getting grants, like you have. We can't get the local grant ("Primary Care Fund"), because we haven't been open 1 year, we can't get 18k for meaningless use because the attestation period has to be in calendar year 2011 (we opened in 2012), and I can't get loan repayment (you have to be a nonprofit to become a HPSA). There are other local grants, similar to the one you mention, but I always wonder if the time is worth it ($/hr spent applying) vs just seeing more patients with that time. It seems one could spend forever on grant writing, then grant reporting, additional record keeping, etc...

One of these years I will make it to the camp and meet some of you other insane types...

P.J.

>

> so ,as we know

> I am not normal like the rest of you I am weird and insnae I do not have

> a good IPA or great payors or a population that is plentiful with good

> payors..I have a lot of stuff I am up agianst

>

> So driving home one night I decided that I d o good work and I should

> get a grant to do more good work becasue noone else was going ot jump out

> and give me money...

>

> so I called up a guy I know. Lawyer. Runs Consumers for affordable Health

> care here in MAine One thing about being an IMP is that over the 7 yrs I

> have been dumb enough to do this I have met all sorts of folks So Joe he

> is always wanting me to contribute to Consumers for affordable Health

> Care. I have no $!! BUT he runs off grants and we mutually think the

> other of us does cool work

> so I call him and say Joe where can I get money?

> And he tells me three foundations that fund Maine projects esp health care

> the first said no not for us The second said sure fill out this

> form(that took me weeks to write it and type it) and after I submitted it,

> becasue the phone call had been required and was the most important part,

> it took 36 hrs to be told yes you get $5,000. and so I never needed the

> third place

> So who do you know who can tell you about grants in your neck of the woods??

> then you write one up

> I would tell you more but typing is painful see below is what I wrote

> I got the money from the BIngham Program but they are MAine based so you

> have to look locally...I figure I can do a little l good and they will not

> know I am insane til the 5,000 is gone:)

> somewhat seriously... it was buying a laptop setting up the IT buying a

> user emr licnese and finding the time to teach the nurse that were the

> barriers , that a small grant got me over the hump for Eventually only I

> will pay her salary but that is not much. I try ot pay her well She got

> out of rn school 1 yr ago and the hospital hired her at 16.oo/hr!!

>

> I have two experience IMP nurses who are training Sara in problem

> solving and coaching--- over Skype:) So all o f us in IMP are great

> resources for each other

>

> Come to IMP camp in October we can talk more and I will see if I have

> gotten anywhere.

>

> Her e is what I wrote You are welcome to steal it for a small fee:

>

>

>

>

>

> What problems, needs, or issues does your proposal address?

>

>

>

> In primary care a key task is to coordinate care. This is difficult to do

> in the current environment, outside of the rare topnotch integrated

> systems. One definition of coordination is to shepherd patients across

> silos of various services and providers; prevent errors and repeated tests;

> identify and share patients' needs and preferences; and avoid conflicting

> plans of care. There is little infrastructure in place to do this. Patients

> interact with both primary care and specialist physicians, and pharmacists,

> nutritionists, and PT/OT etc as well.

>

> There are few clear protocols and expectations around shared care.

>

> Visits are unnecessarily lengthened, errors occur, adverse reactions and

> morbidity are increased, and increased costs occur by addressing

> coordination in the current piecemeal, reactionary manner.

>

>

>

> Describe the program or project for which you seek funding, why you decided

> to pursue this project and whether it is a new or on-going part of your

> organization.

>

> The goal is to design a new program to establish protocols to facilitate

> communication, and to align efforts to improve the care provided by a

> population of providers outside of an employer network. This entails

> designing the program, doing outreach to providers, and hiring staff. Staff

> time would be an RN two hrs a week - working late afternoon or evening on

> the day I am not in the office. This design increases access to my

> practice, and keeps my costs—overhead--low, as no additional work space is

> needed for the new staff member.

>

> Funding is sought to establish a program which will facilitate ongoing

> collaboration and care coordination among practices that care for the same

> population of patients. Practices currently work in silos of processes,

> EMRs, faxes, phones, staffing and office hrs. In addition to reducing the

> burden that current care processes place on patients, having improved

> processes enables me to do my job better and more efficiently and, frankly,

> with greater satisfaction. The goal is to do outreach to establish a

> network of interested committed providers, and to establish processes, then

> follow-up with re -designed office flow and measurable goals for care

> coordination.

>

>

>

> What are the goals, objectives and activities/strategies involved in this

> proposal? A timeline is often helpful to describe your work over time.

>

> The first goal is time consuming-- to hire and train a staff member.

> Estimate 6-24 wks based on a previous training and the need to set up the

> tech infrastructure. This person will be an RN to have the necessary skill

> set.

>

> The next goal is to develop a system to coordinate care, beginning with

> outreach to a set of shared care providers to determine access,

> communication, feedback and other methods to coordinate care among all of

> us. We might have something basic in place inside of two months, but it

> will take a year or longer to flesh out the process.

>

> The third goal is long term --perhaps 1 to 5 yrs—to assess and fine tune

> our work and the ability to measure it,

>

>

>

> Possibilities for communication include Doximity, or Updox, as they are

> secure, or email, or some variety of cloud computing. It maybe that we

> re-institute something this community began and dropped- a consistent hand

> held paper patient portable record. It may be that we provide patients and

> families –who are after all the one link across silos, with a kit to

> facilitate coordination and medication safety. There are several ideas

> brewing about the specifics.

>

> All of these methods have drawbacks and advantages. Hippa is a barrier, as

> is the commitment of the providers involved.

>

>

>

>

>

> Describe the significance of your project: How will it achieve systemic

> change? Does it introduce a new service or program? Will it serve as a

> model program for other organizations or communities? How does your program

> fit into the funding priorities of The Bingham Program?

>

> This project extends primary care to its fullest. In addition, I enhance

> practice capacity and therefore access to primary care.

>

> Patients are not isolated patients of my practice but engage with

> hospitals, pharmacists, specialists, dietitians etc. Without coordination

> patients suffer adverse effects or, at best, missed opportunities for care.

>

> Most primary care practices, of necessity, put their resources into putting

> out fires. Establishing a clear plan is cutting edge. This overlaps the

> intent of the work ACOs are to do but those are complex medico- legal

> organizations, which are based on financial risk and are inaccessible to

> any one local practice that wants to move forward.

>

> This project should be replicable. Other practices may already have staff

> and user licenses etc., so if a program is described and tested, it should

> be possible for practices to replicate this work. Those practices that have

> some overlap in the same specialist use as my practice will find it

> especially easy

>

> This project aligns with The Bingham Program's interest in improved service

> delivery models.

>

>

>

>

>

> What are the positive assets of your organization or community that lead

> you to believe you can address these problems effectively?

>

> This is already an innovative practice. I currently have no in office

> staff .Structured ,at my own expense of lowered income, to leverage

> technology and thus to lower overhead, I have superb access and continuity

> , and have spent seven years building a practice that improves and measures

> access and outcomes.

>

> The 501c3 I work with --Ideal Medical Practices, impcenter.org-- was born

> out of the recognition that solo and small practices are capable of

> delivering high quality care but struggle with obstacles such as lack of

> financing. Ideal Medical Practices provides me with support from a

> nationwide array of folks in similar innovative practices, and also the

> resources of folks trained in QI work at Dartmouth and formerly with the

> IHI.

>

> In this practice I have already gotten one payer to fund me

> differently-globally --away from fee for service-- due to the quality work

> I do. I have presented at IHI, AAFP, Ideal Medical Practices, and been

> published in FPM. This project supports the new model of care delivery I

> have been crafting since opening in June 2005.

>

>

>

>

>

> Do you have plans for evaluating the success of your project? Who will

> conduct the evaluation? How will you use and disseminate the results of the

> evaluation?

>

> The goal is to create a report card of measures:

>

> While there are many published measures of care coordination

> (references/bibliography available), most are limited by being disease

> metric focused .My goal is to measure more globally. Measures are still in

> flux but include the following:

>

>

>

> A. Follow up to consultations / service utilization. I already have a

> rudimentary protocol in place to follow up with patients. I would expand

> and standardize this, and also follow the processes with the outside

> consultants as to quality of communication and appropriateness of

> consultation.

>

> B. Access Often it is hard to get appointment making done -- how

> easy it is to both get an appointment with specialists and how long the

> wait time is can be tracked.

>

> C. Communication Med lists are already given to every patient but

> over time I expect that the med lists in specialists' notes will match up

> better. This can be tracked.

>

> D. Provider satisfaction- reported

>

> E. Reorganize my office flow with a nurse identifying and initiating care

> coordination for identified patients.

>

> F. Continue with current monitoring through the tool HowsYourHealth as to

> preventable ER and hospitalizations.

>

>

>

>

>

>

>

> How will your program or project continue after Bingham Program funding

> ends? Who will help sustain critical program activities?

>

> Without assistance my lone practice's bootstrapping efforts are inadequate

> to finance the onetime costs that overcome the hurdles for the initial set

> up. I need assistance for the time to plan and do the outreach as well as

> to train one part time staffer that will shoulder this workload.

>

>

>

> Once the nurse is trained and protocols are established, I will not need to

> take time away from seeing patients (income producing time), and I

> anticipate that I can see a few more patients per week due to the nurse's

> skill set. This will generate the funds to sustain the program. Nurses can

> also bill for "incident to services "from few payers, or can provide

> services such as a strep test that will allow me to bill for evisits while

> she is present and I am off site- and if she can meet a goal of billing one

> visit at each of her weekly two hr work sessions, that covers her salary.