Patient Centered Medical Patient Centered Medical HomeHome

Pilot Program Pilot Program (PCMH)(PCMH)

Mindi S. Garner, DO, FACPMindi S. Garner, DO, FACP

Pittsburg, KansasPittsburg, Kansas

Veteran’s Day 11/11/11Veteran’s Day 11/11/11

Presentation OutlinePresentation Outline

I.I. My BackgroundMy Background

II.II. Define PCMHDefine PCMH

III.III. Business Model of Medical Business Model of Medical HomeHome

IV.IV. My PCMH ExperienceMy PCMH Experience

V.V. Unique Project With PCMHUnique Project With PCMH

BackgroundBackground

BackgroundBackground

• Raised in Parsons, KS (SEK)Raised in Parsons, KS (SEK)• Undergraduate Undergraduate

• Pittsburg State University in Pittsburg State University in PittsburgPittsburg

• Medical SchoolMedical School• Oklahoma State University-COM, Oklahoma State University-COM,

TulsaTulsa• Graduated 2000Graduated 2000

BackgroundBackground

• Residency in Internal MedicineResidency in Internal Medicine• University of Tennessee-MemphisUniversity of Tennessee-Memphis• June 2000-July 2003June 2000-July 2003

• Private Practice 12/1/03Private Practice 12/1/03• Pittsburg, Kansas Pittsburg, Kansas • Straight out of ResidencyStraight out of Residency

Traditional Medical Traditional Medical PracticePractice

• Solo Independent General Solo Independent General InternistInternist

• Both In-patient & Out-patientBoth In-patient & Out-patient• Active staff privilegesActive staff privileges

• Via Christi Hospital, Pittsburg, KSVia Christi Hospital, Pittsburg, KS• Girard Medical Center, Girard, KSGirard Medical Center, Girard, KS

• 2 clinics: Pittsburg and Girard2 clinics: Pittsburg and Girard• Share call with 5 other InternistsShare call with 5 other Internists

EMR BackgroundEMR Background

• First Fully Functional EMR in First Fully Functional EMR in SEKSEK• Started from Day 1Started from Day 1

• Fully IntegratedFully Integrated• WebsiteWebsite• E-scriptsE-scripts• Lab Result IntegrationLab Result Integration• Patient PortalPatient Portal• Secure email messagingSecure email messaging

Control of BusinessControl of Business

• Trained in EMR Trained in EMR andand PM Software PM Software• Trained in every office activityTrained in every office activity• Do own codingDo own coding• Do Own Charge EntryDo Own Charge Entry• Review every aspect of cash flowReview every aspect of cash flow• Practice cost-conscious medical Practice cost-conscious medical

carecare

Defining PCMHDefining PCMH

Concerns?Concerns?

• Medicare Physician Medicare Physician ReimbursementReimbursement

• Commercial Insurance TrendCommercial Insurance Trend• Recovery Audit Contractor Recovery Audit Contractor

ProgramProgram• Healthcare ReformHealthcare Reform• Unsustainable Payment Unsustainable Payment

StructureStructure

Motivation Difficulties?Motivation Difficulties?

• Who wouldn’t have difficulties?Who wouldn’t have difficulties?• Physicians are human!Physicians are human!• Odds stacked against us?Odds stacked against us?• Frightened?Frightened?• I share your concernsI share your concerns• I am in the same situation you I am in the same situation you

areare• Our livelihood is in jeopardyOur livelihood is in jeopardy

FrustrationsFrustrations

• Anyone understand what we Anyone understand what we are going through?are going through?

• Need to be a PCP to know Need to be a PCP to know challenges that occur everydaychallenges that occur everyday

• Specialists are also involvedSpecialists are also involved• Equal Opportunity Equal Opportunity

What is the solution?What is the solution?

• Times are changingTimes are changing• Reform needs Physician LeadershipReform needs Physician Leadership• Innovative IdeasInnovative Ideas• ““Think outside the box”Think outside the box”• Extreme conditions require unique Extreme conditions require unique

approachesapproaches• Perfect OpportunityPerfect Opportunity• Everyone is looking to us for Everyone is looking to us for

solutionssolutions

What is a PCMH?What is a PCMH?

• PCMH is an acronym for the PCMH is an acronym for the Patient-Patient-Centered Medical Home Centered Medical Home model of caremodel of care

• It is It is notnot a brick and mortar building a brick and mortar building• It is a set of principlesIt is a set of principles• It is a It is a more effective model more effective model of health of health

care delivery care delivery

PCMHPCMH16

Definition adopted in Kansas law, 2008The definition of a medical home according to Kansas law (K.S.A. 75-7429) is: “A health care delivery model in which a patient establishes an ongoing relationship with a physician or other personal care provider in a physician-directed team, to provide comprehensive, accessible and continuous evidence-based primary and preventive care, and to coordinate the patient’s health care needs across the health care system in order to improve quality and health outcomes in a cost effective manner.”

Patient-Centered Patient-Centered Medical HomeMedical Home

• BackgroundBackground• American Academy of PediatricsAmerican Academy of Pediatrics• Concept introduced 1967Concept introduced 1967

• Central location of child’s medical Central location of child’s medical recordrecord

• Policy Statement 2002Policy Statement 2002• Expanded conceptExpanded concept

What does a PCMH do?What does a PCMH do? The PMH puts patients at the The PMH puts patients at the

centercenter of the health care system, and of the health care system, and provides primary care that is provides primary care that is

“accessible, continuous, “accessible, continuous, comprehensive, family-centered, comprehensive, family-centered, coordinated, compassionate, and coordinated, compassionate, and

culturally effective.” culturally effective.”

Patient-Centered Patient-Centered Medical HomeMedical Home

• PrinciplesPrinciples• Personal physicianPersonal physician• Physician directed medical practicePhysician directed medical practice• Whole person orientationWhole person orientation• Care is coordinated and/or Care is coordinated and/or

integratedintegrated• Long-term healing patient-Long-term healing patient-

physician relationship instead of physician relationship instead of episodic treatmentsepisodic treatments

PCMHPCMH

• Focuses on expanded Focuses on expanded communication between communication between patient and PCMH teampatient and PCMH team

Just Cut to the Chase!Just Cut to the Chase!

Healthcare Reform Healthcare Reform OUROUR Way! Way!

Physician Led-The Right Way!Physician Led-The Right Way!

Reality Check: American Reality Check: American HealthcareHealthcare

• Exploding costsExploding costs• FFS drives volume over quality, fosters FFS drives volume over quality, fosters

fragmentation over coordinationfragmentation over coordination• Lagging qualityLagging quality• Poor satisfactionPoor satisfaction• Misaligned incentivesMisaligned incentives• Physician workforce “perfect storm”Physician workforce “perfect storm”• Primary care is critical, and a fundamental Primary care is critical, and a fundamental

answer to the health economics in USanswer to the health economics in US• Quality MUST increase, cost MUST stabilizeQuality MUST increase, cost MUST stabilize

Money Saving OptionsMoney Saving Options

• There are ONLY 4 options to There are ONLY 4 options to change the basic economics:change the basic economics:• Serve fewer peopleServe fewer people• Provide fewer servicesProvide fewer services

• Rationing, quotasRationing, quotas• Pay less per servicePay less per service

• rationing by no willing providersrationing by no willing providers• Fundamentally change how services are paid Fundamentally change how services are paid

and/or system is organizedand/or system is organized• Increased prevention/primary careIncreased prevention/primary care• PCMH, ACOsPCMH, ACOs

What is a Patient Centered What is a Patient Centered Medical Home?Medical Home?

• A vision of health care as it should A vision of health care as it should bebe

• A framework for organizing A framework for organizing systems of care at both the systems of care at both the micro (practice) and macro micro (practice) and macro (society) level(society) level

• A blueprint or pathway to A blueprint or pathway to excellent healthcare for excellent healthcare for individuals or a populationindividuals or a population

PCMH VideoPCMH Video

http://www.emmisolutions.com/medicalhome/transformed/english.htmlhttp://www.emmisolutions.com/medicalhome/transformed/english.html

Physician LeadershipPhysician Leadership

• Natural LeadersNatural Leaders• This is what we do every day!This is what we do every day!• We are the authority in patient We are the authority in patient

care so allow us to pave the care so allow us to pave the way!way!

• We can develop the plan to take We can develop the plan to take care of our patientscare of our patients

• This is our obligationThis is our obligation

PCMHPCMH

• Hallmarks of Medical HomeHallmarks of Medical Home• Practices advocate for their patientsPractices advocate for their patients• Evidence-based medicineEvidence-based medicine• Voluntary performance measurementVoluntary performance measurement• Patients participate in decision-makingPatients participate in decision-making• Informational Technology utilizationInformational Technology utilization

• Enhanced Access to ClinicEnhanced Access to Clinic

Business Model of Business Model of PCMHPCMH

• Three-Part Payment ModelThree-Part Payment Model• Monthly Care Coordination Monthly Care Coordination

PaymentPayment• Visit-Based Fee-For-Service Visit-Based Fee-For-Service

ComponentComponent• Performance-Based ComponentPerformance-Based Component

PCMHPCMH

• Payment Reflects Value of Medical Payment Reflects Value of Medical HomeHome• Reflects value of work outside visitReflects value of work outside visit• Pay for coordination of carePay for coordination of care• Support provision of enhanced Support provision of enhanced

communication via email or phonecommunication via email or phone• Recognize value of physician work Recognize value of physician work

remotelyremotely• Separate payments for face-to-face Separate payments for face-to-face

visitsvisits

PCMHPCMH

• Payment Reflects Value of Payment Reflects Value of Medical HomeMedical Home• Recognize case mix differences in Recognize case mix differences in

patient populationpatient population• Allow physicians to share in Allow physicians to share in

savings from reduced savings from reduced hospitalizationshospitalizations

• Additional payments for Additional payments for continuous quality improvementscontinuous quality improvements

Team ApproachTeam Approach• Health care is delivered by a systemHealth care is delivered by a system• Implies a multidisciplinary teamImplies a multidisciplinary team• Each member operates top of license Each member operates top of license • Variety of disciplinesVariety of disciplines• Collaborative parallel effort is normCollaborative parallel effort is norm• Shared decision making and Shared decision making and

accountabilityaccountability• Paradigm and legal shiftParadigm and legal shift

Rationale for moving toward Rationale for moving toward PCMHPCMH

Provides framework for sustainable process improvement

Supports the Joint Commission Hospital Accreditation process

Lays foundation for Accountable Care Organization (ACO) model

Leverages support from Kansas PCMH Initiative (2011-2013) program

Improves population health

My Role in PCMHMy Role in PCMH

• Chosen as 1 of 8 clinics in KansasChosen as 1 of 8 clinics in Kansas• Huge HonorHuge Honor• Pilot ProgramPilot Program• 2 years in duration2 years in duration• Provides resources to embrace Provides resources to embrace

changechange• ““It’s what you make it” It’s what you make it” • ““EMR Meaningful Use” compatibleEMR Meaningful Use” compatible

Sites Selected for the Sites Selected for the PilotPilot

• American Medical Practice of Winfield/Augusta Family American Medical Practice of Winfield/Augusta Family Practice, PA, Winfield Practice, PA, Winfield

• Cheyenne County Clinic, Cheyenne County Hospital, St. Cheyenne County Clinic, Cheyenne County Hospital, St. Francis Francis

• Ellsworth County Medical Center and Rural Health Clinic, Ellsworth County Medical Center and Rural Health Clinic, Ellsworth Ellsworth

• Mindi S. Garner, D.O., Chartered, Pittsburg Mindi S. Garner, D.O., Chartered, Pittsburg • Great Plains of Sabetha, Inc. dba Sabetha Family Practice, Great Plains of Sabetha, Inc. dba Sabetha Family Practice,

Sabetha Sabetha • Internal Medicine Group, PA, Lawrence Internal Medicine Group, PA, Lawrence • KU Wichita Adult Medicine, University of Kansas School of KU Wichita Adult Medicine, University of Kansas School of

Medicine – Wichita, Medical Practice Association, Wichita Medicine – Wichita, Medical Practice Association, Wichita • Post Rock Family Medicine, PlainvillePost Rock Family Medicine, Plainville

35

Practice Redesign ToolPractice Redesign Tool

• TransforMEDTransforMED• Non-profit subsidiary of the Non-profit subsidiary of the

American Academy of Family American Academy of Family Physicians (AAFP)Physicians (AAFP)

• Started in 2005Started in 2005• MissionMission

• The transformation of health care The transformation of health care delivery to achieve optimal patient delivery to achieve optimal patient care, professional satisfaction and care, professional satisfaction and success of primary care practices. success of primary care practices.

My Motivation!My Motivation!

PCMHPCMH

• Perfect OpportunityPerfect Opportunity• Needed a new focusNeeded a new focus• Embracing “Change”Embracing “Change”• No longer the “strongest No longer the “strongest

survive”, it is the “most able to survive”, it is the “most able to change” survivechange” survive

• Flexibility is keyFlexibility is key• Sometimes painful processSometimes painful process

PCMHPCMH

• Must open practice to critiquesMust open practice to critiques• Prepare to change workflowsPrepare to change workflows• The 8 clinics help each otherThe 8 clinics help each other

• Group Conference Calls Each MonthGroup Conference Calls Each Month

• Access to online, collaborative Access to online, collaborative network: Delta Exchangenetwork: Delta Exchange• Assistance to aid transformation Assistance to aid transformation

processprocess

My Experience with My Experience with PCMHPCMH

How Did We Get How Did We Get Started?Started?

• Attended the first PCMH Pilot Attended the first PCMH Pilot Program meetingProgram meeting

• Motivational Speakers Started Motivational Speakers Started ProcessProcess

• My Self-Evaluation StartedMy Self-Evaluation Started• Humbling AssessmentHumbling Assessment• Control Issue was causing Control Issue was causing

stagnationstagnation

Self-EvaluationSelf-Evaluation

• I was interrupting staff workflowI was interrupting staff workflow• Staff SurveyStaff Survey

• Job satisfactionJob satisfaction• Anonymous feedback on frustrationsAnonymous feedback on frustrations

• Lack of pre-visit planningLack of pre-visit planning• ““huddles”huddles”

• Brainstorming Session with Brainstorming Session with follow upfollow up

““Clinic Overhaul” Clinic Overhaul” DetailsDetails

• Everyone works to the top of their licenseEveryone works to the top of their license• Created Lab Order ProtocolCreated Lab Order Protocol• Created Phone Note Protocol TemplateCreated Phone Note Protocol Template

• Same information format each and every timeSame information format each and every time

• Regularly Scheduled Office Staff MeetingsRegularly Scheduled Office Staff Meetings• Prescription Refill ProtocolPrescription Refill Protocol• New, easier to maneuver EKG machineNew, easier to maneuver EKG machine• Perform Dermatology procedures in-housePerform Dermatology procedures in-house

““Clinic Overhaul” Clinic Overhaul” DetailsDetails

• Created additional signing Created additional signing privilegesprivileges

• Completed Policies/Procedures Completed Policies/Procedures Manual for staffManual for staff

• Every employee is trained for Every employee is trained for front-desk dutiesfront-desk duties

• More open-access appointment More open-access appointment slotsslots

““Clinic Overhaul” Clinic Overhaul” DetailsDetails

• Patient PortalPatient Portal• Secure emailSecure email• Empower patients with their own Empower patients with their own

datadata• Increased communicationIncreased communication• Copies of clinical summary at end Copies of clinical summary at end

of visitof visit• Copies of med listCopies of med list

Practice ImplicationsPractice Implications

• Challenges of TransformationChallenges of Transformation• Initial Capital and Restructuring Initial Capital and Restructuring

CostsCosts• Ongoing support and maintenanceOngoing support and maintenance• Reporting on quality, cost and Reporting on quality, cost and

satisfactionsatisfaction• Implementing HITImplementing HIT• Information OverloadInformation Overload

Practice ImplicationsPractice Implications

• Shifting “power”Shifting “power”• Too much change to manage Too much change to manage

anywayanyway• Job Duties completely revampedJob Duties completely revamped• Possible Staff ObjectionsPossible Staff Objections• Doctor has to be willing to Doctor has to be willing to

embrace change for staff to followembrace change for staff to follow

ChangeChange

• Change is difficult but requiredChange is difficult but required• Embracing change is hard but Embracing change is hard but

it is easier when you are in a it is easier when you are in a “not so happy place”“not so happy place”

• Eliminate anger, frustration, Eliminate anger, frustration, despairdespair

Assessing Value in PCPAssessing Value in PCP

• PCMH just gives name of what we do PCMH just gives name of what we do • Enables proper compensationEnables proper compensation• Describes the workflow of primary careDescribes the workflow of primary care• Foundation of medical careFoundation of medical care• Communicates our unique perspectiveCommunicates our unique perspective• No other “branch” of medical tree similarNo other “branch” of medical tree similar• Without primary care, medical Without primary care, medical

treatments are disorganizedtreatments are disorganized

I already do this! But…I already do this! But…

• PCMH puts a more PCMH puts a more formalizedformalized name on name on “patient and family centered care.”“patient and family centered care.”

• PCMH can generate PCMH can generate support support as the model as the model proves it improves care and reduces cost proves it improves care and reduces cost across the health care systemacross the health care system

• PCMH gives us the PCMH gives us the opportunityopportunity to more to more clearly define how we can work together clearly define how we can work together more effectively for our patients and their more effectively for our patients and their familiesfamilies

I do this anyway!I do this anyway!

• Need to describe our work Need to describe our work functions in order to even attempt functions in order to even attempt to be compensated for “scut to be compensated for “scut work”work”

• Likely not same way each Likely not same way each encounterencounter

• Follow systematic way to provide Follow systematic way to provide the same care each and every the same care each and every time with every patienttime with every patient

Why Patient Centered Medical Home?Why Patient Centered Medical Home?

• The Patient Centered Medical Home creates a The Patient Centered Medical Home creates a frameworkframework for change for change

• The Patient Centered Medical Home creates a The Patient Centered Medical Home creates a common common languagelanguage for change for change

• The Patient Centered Medical Home creates an The Patient Centered Medical Home creates an opportunityopportunity for change for change

• The framework, language and opportunity for The framework, language and opportunity for meaningful Clinical Integrationmeaningful Clinical Integration

8

Minutia?Minutia?

• Curbside consultsCurbside consults• Filling Out PaperworkFilling Out Paperwork

• DisabilityDisability• Nursing Home documents and Nursing Home documents and

issuesissues• Review consultationsReview consultations

• Communicating with patientsCommunicating with patients• These all add upThese all add up

Today’s Care Medical Home Care

Our patients are those who are registered in our medical home

Care is determined by today’s problem and time available today

Care is determined by a proactive plan to meet health needs, with or without visits

Care varies by scheduled time and memory or skill of the doctor

Care is standardized according to evidence-based guidelines

Patients are responsible for coordinating their own care

A prepared team of professionals coordinates all patients’ care

I know I deliver high quality care because I’m well trained

We measure our quality and make rapid changes to improve it

It’s up to the patient to tell us what happened to them

We track tests and consultations, and follow-up after ED and hospital

Clinic operations center on meeting the doctor’s needs

An interdisciplinary team works at the top of our licenses to serve patients

My patients are those who make appointments to see me

The PCMH concept advocates enhanced access to The PCMH concept advocates enhanced access to comprehensive, coordinated, evidence-based, comprehensive, coordinated, evidence-based,

interdisciplinary careinterdisciplinary care

Why PCMH matters to HCPsWhy PCMH matters to HCPs

Physicians & StaffPhysicians & Staff

• Happier staffHappier staff• Happier physiciansHappier physicians• Increased net revenueIncreased net revenue• Team-based careTeam-based care• Long-term returns from Long-term returns from

transformationtransformation• Increased standardization of Increased standardization of

carecare• Improved patient safetyImproved patient safety• Better communication Better communication

reducing riskreducing risk

PatientsPatients

• Improved satisfactionImproved satisfaction• Improved preventive careImproved preventive care• Improved quality measuresImproved quality measures• Reduced ED utilizationReduced ED utilization• Reduced readmissionsReduced readmissions• Reduced hospitalizationsReduced hospitalizations• Longer team-based Longer team-based

appointments; enhanced appointments; enhanced communicationcommunication

• Reduced per capita cost for Reduced per capita cost for certain chronic conditionscertain chronic conditions

The Future of Primary The Future of Primary CareCare

• PCMH Concept Emphasizes PCMH Concept Emphasizes TeamworkTeamwork• Usual reason why doctors don’t Usual reason why doctors don’t

choose PCchoose PC• PCP’s usually don’t have helpPCP’s usually don’t have help

• Team Meetings are a PriorityTeam Meetings are a Priority• The “Glue” that keeps team The “Glue” that keeps team

togethertogether

• You are not alone!You are not alone!

The Future of Primary The Future of Primary CareCare

• Primary Care PhysiciansPrimary Care Physicians• Career Satisfaction at all time lowCareer Satisfaction at all time low

• Change the delivery of careChange the delivery of care• Save primary careSave primary care

• Desire to improve outcome for Desire to improve outcome for our patientsour patients

• Need right balance PC + Need right balance PC + SpecialistsSpecialists

The Future of Primary The Future of Primary CareCare

• Doctors go to work every day Doctors go to work every day wanting to serve our patients wanting to serve our patients better and we feel badly about better and we feel badly about itit

• You can do something about itYou can do something about it• Stronger primary Stronger primary

care=Healthier Patientscare=Healthier Patients

The Future of Primary The Future of Primary CareCare

• The influence of the PCMHThe influence of the PCMH• Encourage future primary care Encourage future primary care

doctorsdoctors• If done correctly this could re-If done correctly this could re-

energize primary careenergize primary care• Intertwines with a unique Intertwines with a unique

programprogram

Unique Project with Unique Project with PCMHPCMH

Teach By ExampleTeach By Example

• ““Premeds with Promise, Inc.Premeds with Promise, Inc.””• Introduced February 2004Introduced February 2004• Pittsburg State University StudentsPittsburg State University Students• Pre-Medicine MajorsPre-Medicine Majors• Serve as Medical AssistantsServe as Medical Assistants

• Student-EmployeesStudent-Employees

• Pre-Med Advisors’ HelpPre-Med Advisors’ Help• ““Win-Win” Scenario Win-Win” Scenario

Premeds with Promise, Premeds with Promise, Inc.Inc.

• On the Job TrainingOn the Job Training• Confirms CommitmentConfirms Commitment• Opportunity to change path earlyOpportunity to change path early

• Exposed to lifestyleExposed to lifestyle• On-CallOn-Call• Post-CallPost-Call• BenefitsBenefits

• Extremely ImpressionableExtremely Impressionable

Premeds with Promise, Premeds with Promise, Inc.Inc.

• Experience interaction between Experience interaction between doctorsdoctors• Attend after-hours meetingsAttend after-hours meetings• Grasp camaraderie first-handGrasp camaraderie first-hand• Assess “Rite of Passage” up closeAssess “Rite of Passage” up close

• Realize True CommitmentRealize True Commitment• At my side during workdayAt my side during workday

• Colleague AppreciationColleague Appreciation

Premeds with Promise, Premeds with Promise, Inc.Inc.

• C-CorporationC-Corporation• Protects:Protects:

• Students’ InterestsStudents’ Interests• Integrity of ProgramIntegrity of Program• Sole ResponsibilitySole Responsibility• TrustTrust• Maintain goal of programMaintain goal of program

Premeds with Promise, Premeds with Promise, Inc.Inc.

• Separate PayrollSeparate Payroll• HIPAA TrainedHIPAA Trained• Worker’s Compensation Worker’s Compensation

CoverageCoverage• Open Door PolicyOpen Door Policy

Premeds with Promise, Premeds with Promise, Inc.Inc.

• Letters of RecommendationLetters of Recommendation• Work Ethic Witnessed First-HandWork Ethic Witnessed First-Hand• Detailed LetterDetailed Letter

• Compared to ShadowingCompared to Shadowing

• Creating competent colleaguesCreating competent colleagues

Job DutiesJob Duties

• Answer PhoneAnswer Phone• Complete flag requestsComplete flag requests• Check care plan after visit completedCheck care plan after visit completed

• Obtain all requested informationObtain all requested information

• Complete Phone NotesComplete Phone Notes• Assist in Dermatological ProceduresAssist in Dermatological Procedures• Document Preventive Care MeasuresDocument Preventive Care Measures

Academic TrainingAcademic Training

• Start update in EMRStart update in EMR• Record CC, HPI, VitalsRecord CC, HPI, Vitals• Confirm medication changesConfirm medication changes• Prepare for SOAP Note completionPrepare for SOAP Note completion• List all preventive care measures List all preventive care measures

in plan at bottom of notein plan at bottom of note• Just a glance at “Flowsheet View”Just a glance at “Flowsheet View”

Premeds with Promise, Premeds with Promise, Inc.Inc. “Scribes” “Scribes”

• Perform “Doctor Duties”Perform “Doctor Duties”• Up Close Interaction With Up Close Interaction With

PatientsPatients• Rare opportunityRare opportunity• Witness powerful relationshipWitness powerful relationship

• Patient and DoctorPatient and Doctor

• Experience the Doctor RoleExperience the Doctor Role• Advantages for DoctorAdvantages for Doctor

Premeds with Promise, Premeds with Promise, Inc.Inc.

• Involved in Involved in every aspectevery aspect of business of business• Rare OpportunityRare Opportunity

• Hindsight PerspectiveHindsight Perspective

• Premeds do payment entryPremeds do payment entry• SupervisionSupervision• Need Expert on SoftwareNeed Expert on Software

• Avoid OutsourcingAvoid Outsourcing• Decrease costsDecrease costs

Girard Satellite ClinicGirard Satellite Clinic

• Completely Premed ManpowerCompletely Premed Manpower• 3 Premeds at each clinic half-3 Premeds at each clinic half-

dayday• Drive company car from Drive company car from

Pittsburg Pittsburg

Premeds with Promise, Premeds with Promise, Inc.Inc.

• Future physicians of our Future physicians of our communitycommunity• Retiring community physiciansRetiring community physicians• Alumni of local universityAlumni of local university• Good experience with physiciansGood experience with physicians

Premeds with Promise, Premeds with Promise, Inc.Inc.

• Ultimate GoalUltimate Goal• Emphasis on Primary CareEmphasis on Primary Care• My Clinic is Launching Pad after My Clinic is Launching Pad after

ResidencyResidency• Rural Community GrantsRural Community Grants• Stay however long they wantStay however long they want• 11stst group is beginning 2nd year of group is beginning 2nd year of

ResidencyResidency

The NumbersThe Numbers

• Current Premeds on Payroll: 14Current Premeds on Payroll: 14• Past/Current Premeds: 54Past/Current Premeds: 54• Presently in Medical School: 16Presently in Medical School: 16• Residency: 10Residency: 10• Primary Care Residency: 7Primary Care Residency: 7• MD or DO + MBA: 7MD or DO + MBA: 7

Mission StatementMission Statement

Providing a Patient-Centered Providing a Patient-Centered Medical Home For The Local Medical Home For The Local

Community While Cultivating The Community While Cultivating The Resource Of Our Youth, Who Are Resource Of Our Youth, Who Are

Driven To Achieve The Driven To Achieve The Professionalism And Discipline Professionalism And Discipline

Necessary To Advance The Necessary To Advance The Practice Of Medicine.Practice Of Medicine.

PSU Homecoming PSU Homecoming Parade 2011Parade 2011

HighlightsHighlights

• Patient-Centered Medical Patient-Centered Medical HomeHome• The Present and Future “Buzz The Present and Future “Buzz

Word”Word”

• Healthcare ReformHealthcare Reform• Physicians Leading the WayPhysicians Leading the Way• Motivate by exampleMotivate by example

• Re-energize Primary CareRe-energize Primary Care

What’s Next?What’s Next?

• Pilot Program Data CompilationPilot Program Data Compilation• Use data as foundation for changeUse data as foundation for change• Every practice can begin processEvery practice can begin process• Begins with self-evaluationBegins with self-evaluation

• Where are you now and where do Where are you now and where do you want to be in your practice?you want to be in your practice?

• PCMH is a reality!PCMH is a reality!

Questions?Questions?

Contact InformationContact Information

Mindi S. Garner, DO, FACPMindi S. Garner, DO, FACPwww.garnercares.comwww.garnercares.com

docmsg@garnercares.comdocmsg@garnercares.comwww.premedswithpromise.comwww.premedswithpromise.comdoctobe@premedswithpromise.doctobe@premedswithpromise.

comcom127 West 5127 West 5thth Street, Pittsburg, KS 66762 Street, Pittsburg, KS 66762

620-232-7900(p)------620-232-7901(f)620-232-7900(p)------620-232-7901(f)