1. Marcus Welby, Robo Doc Or Something In Between Core Metrics That Matter Quality Partners of Rhode Island CSI Project February 18, 2011 Sue Houck Houck & Associates, Inc Boulder, CO

2. Start With The End in Mind What 1-3 things would you most like to accomplish in the next year at your practice?

3. Beyond the Hamster Wheel A few key metrics that drive work volumes and capacity to respond have a big impact on whether work flows smoothly in the office.

4. Metrics Matter Number of patients for whom you provide care Your “capacity” or supply of days worked per year, number of appointments per day Average number of visits per patient per year

5. If YOU Have 2,000 patients Who average 2.7 office visits/year How many office visits would they require/year?

6. If YOU Work 230 days a year Have 20 appointment slots available per day What is your office visit “supply”?

7. Demand 4,600 office visits/year Supply 5,400 office visits/year Vs.

8. Supply Demand Would it be useful to know your demand vs. supply of office visits?

9. Supply Demand Does your ratio of demand vs. supply impact whether you have a “great” year at work?

10. What Would You Advise Your med school friend and Family Medicine physician Ben Francisco who lives in Maryland wants some advice. He has been using an EHR for 6 months, and likes it though complains that using it takes much longer to see patients. Entering the history alone takes about 1/3 of his visit time. Ben has one full time RN who assists himself and another physician with whom he shares ownership of the practice. He does not employ any mid-levels, and relies on individual 1:1 office visits but he is looking for answers and is committed to changing what he’s been doing. He has 2,200 patients who average 2.5 visits per year and is in the office 240 days per year, 20 available appointments each day. He uses two exam rooms and frequently waits for his nurse.

11. What Would You Advise Ben begins his day with reviewing lab and procedure results and entering them into the EHR for about ½ hour. He routinely checks patient blood pressure and does med reconciliatation for each patient, which his nurse also does. Ben’s question to you is, “what can I do differently?” Every year I talk about change but nothing happens. I love my work with patients, but can’t go on like this. I have even considered leaving medicine.” What would you advise?

12. Leverage Points What Can Ben Control? YesNo Number of patients for whom he provides care How often patients are seen Number of clinical support staff Alternatives to 1:1 office visit e.g. group visits What he does at each visit

13. Leverage Points What Can He Control?YesNo Non-visit work e.g. refills, lab and procedure results, phone calls, EHR documentation Number of exam rooms Use of mid-level staff-e.g. nurse practitioner Other

14. Metrics Matter Would knowing and using these metrics affect your effectiveness as a Patient Centered Medical Home? Your capacity to participate in an Accountable Care Organization?

15. Continuing to do things the same way will yield the same results