February 2015 Newsletter Tim Burns

QHN March eNewsletter

Interview with Tim Burns recently retired Chief Administrative Officer from Glenwood Medical Associates.

Retiring Glenwood Medical Associates, Tim Burns Leaves 25-year Legacy

Managing a medical practice today is far more complex than almost any other small business, and the pace of change is staggering. The standards that were predominating a generation ago no longer drive the rapidly evolving relationship between physicians, patients and healthcare organizations. Other entities, most notably payers and regulators, have imposed themselves into the relationship making for complex and intense internal and external pressures.

The mark of a good Practice Manager is the ability to help their practice navigate the business related changes, so the practitioners can focus on practicing medicine. Tim Burns, Chief Administrative Officer at Glenwood Medical Associates (GMA), a large multi-specialty practice, is just such an individual. He started his tenure at GMA in 1989; it was an 8 physician practice. Today GMA has grown to 24 providers, more than 90 staff members, multiple site locations and they are a Patient Centered Medical Home (PCMH), participate in the Comprehensive Primary Care (CPC) initiative and are part of the region 1 Regional Care Collaborative Organization (RCCO).

QHN’s Senior Account Manager, Sherri Corey, asked Tim if he would share his thoughts and reflections on his 25 years in the industry, how health information technology has changed the practice of medicine and what the healthcare future holds. Below are some excerpts from the conversation.

SC: How has implementing an EHR helped, changed GMA?
TB: Over the years it has absolutely helped. GMA invested in 1995 in a state of the art EHR, back then that was really only a data repository. Although it saved money and provided greater efficiency over the time of managing a medical record for a medium sized clinic, it did not have much “minable data” like we have today to report quality measures. Nevertheless, it allowed the flexibility for providers to access EHR data remotely and helped us address HIPAA, in a much more efficient manner. For a medium to large practice I do not believe that a paper chart system could work. It would take an army of people to meet certain industry standards or pay for performance requirements.

SC: What is the ROI in being connected to QHN/HIE?
TB: It is in staffing and not having to deal with paper records. That was very time consuming especially as more and more data was coming becoming essential for medical decision making by our PCP’s and specialist. Also, the secure messaging is a value that improved their overall referral process inbound and outbound for specialty and primary care. QHN made for much more efficient care transitions.

SC: Where do you find value in having your EHR interfaced with the HIE?
TB: It was definitely a challenge to get it started and set up, but once it was completed, it brought tremendous amount of efficiencies and value. We were able to bring patient information into our EHR though interfaces that allowed discreet data. We were getting data from all the hospitals and other outside health care facilities. Before the HIE the data was not managed as well. With the HIE it helped GMA with the Meaningful Use requirements and qualify for CPC. In part and as a result, GMA became recognized by NCQA as a level 3 PCMH facility. Which was all part of our organizations strategic plan established back in the fall of 2012. Thru these quality and pay for performance programs it qualified GMA to receive significant MU funding and CPCi PMPM attribution payments. These funds helped cover cost of software and new quality systems of support. This eventually led to the hiring or appointing of staff for Quality Director, Transitional Care Coordinator, Referral Coordinator, High Risk Care Coordinator/manager, etc.

Thankfully through RMHP and the Beacon Project, GMA also learned process improvement (PDSA) and could access many other resources thru the Beacon’s learning collaboratives. The Beacon helped us with other grant opportunities that supported our efforts to achieve PCMH.

SC: What challenges did you face in “selling” the value of connectivity to the HIE?
TB: Being able to really show the providers the value of the technology. In many cases, the workflow is done for them and they just think it is the EHR making it all work together. They do not realize the back story or how the data got there. Because a successful integration with the HIE is technology driven it takes a fair amount of resources and staff to support it. To set it up and help manage the data on the provider side you have to have a point person to manage and oversee the project. Cindy Rafert, GMA Medical Records Manager provides the coordination with the various systems and the IT department. She makes the HIE work for GMA. It is an evolution and transitional process to find the most value in these systems.

SC: What are GMA’s challenges today?
TB: GMA is still challenged with the integration of Behavioral Health and Nutrition Counseling. We need to see more integration of these services.

SC: What does the future hold?
TB: I’m excited about the initiatives QHN is working on like Crimson Care Management (CCM), SIM grant, Imaging Sharing, and developing value on pay for performance models. There is low hanging fruit in doing so, for example; better patient management on high risk patients particularly in transitions of care.

In the “Fee for Service world” traditionally providers are used to the patients coming into the office where the Physician or NP does the assessment. We are all learning this provides a very limited exposure of what the overall patient experience is toward wellness. There are environmental and social aspects that affect the patient that the providers never see. They may hear it, but not lay their eyes on it and touch it.

Hearing the stories from the GMA transitional care team about the high risk for these patients, I believe there is opportunity for better patient care which is going to require a movement away from quantity to quality. Today, the healthcare system is limited given the lack of PCP’s and care teams to reach out to the patient in more meaningful ways. However, over time I believe payers will see value and cost savings in this broader view of patient care and it will lead to better reimbursement for PCPs.

The addition of new staff roles within the practice, such as the Quality Director position, which has been invaluable for the different initiatives we have been working on. Rob Nelson, PA Quality Director was key in guiding our organization through the maze of programs with CPC and PCMH as well as some Meaningful Use issues. Further, our Medical Director Dr. Paul Salmen, and myself were able to allocate more and more time to practice transformation systems to help improve the practice. Ultimately, the goal is to achieve the triple aim approach to care. Certainly easier said than done and perhaps a process that truly never ends. A good example is the reassignment of one of our terrific nurse practitioners, Sara Oliver, ANP who took on the role as High Risk Care Coordinator/manager. She is actually doing some home visits for patients who are high risk such as the elderly and frail patients. This allows her to go out and clinically assess risk on patients that are coming out of the hospital, nursing home, etc. in their living environment where providers do not have that exposure, this is very revealing in helping to improve patient care.

SC: Where do you see EHR / HIE / technology going in the future?
TB: With healthcare being almost 1/5 of the economy and growing, yet the poor quality to comparative cost with other nations, the US does not have a choice but to continue to integrate care through technology. The problem is exactly what Winston Churchill said, “You can always count on Americans to do the right thing - after they've tried everything else,” with that I mean, the country probably needs one system that supports national HIE - a system that crosses the entire continuum from PCP, hospitals, LTC, HH, and finally the funeral home and back to the family.
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