For one California physician group, the key to improved quality of care was right in the palms of their hands. And for a hospital-owned medical practice in Ohio, an office redesign helped lead to big gains in patient care and patient satisfaction.
For the staff of California Emergency Physicians Medical Group, Oakland, its "Palm Program" meant reduced medical errors, faster and better access to medical records and treatment information, and improved patient outcomes. The practice has more than 800 emergency room physicians, nurse practitioners and physician assistants treating more than 1.7 million patients throughout California. CEP received an honorable mention in the physician group practice category of the 2001 Excellence in Risk Management Awards, along with Painesville, Ohio-based Prime Health Medical Group and its entry, "Quality at the Point of Service."
Although the judges were impressed by both entries, they were prepared to name CEP the winner. However, the organization failed to document the financial impact of its program, a requirement for the competition. Because the program was launched earlier this year, CEP officials said comprehensive financial data were not yet available. So neither entrant was designated a winner.
Judge Eric Knox, M.D., director of patient safety for Children's Hospital in Minneapolis, lauded CEP's proposal for its "very efficient use of resources and good use of information technology." Other judges praised the group's focus on reducing medical errors.
Wesley Curry, M.D., an ER physician and president of CEP, says his group also operates a malpractice insurance company, MedAmerica Mutual, based in Oakland, which offered to subsidize what started out as a small demonstration project to equip about 100 doctors with handheld computers. But some 600 of the ER physicians wanted the computers, and MedAmerica ended up spending more than $100,000 to offset the cost to physicians. Curry says the results so far have been encouraging.
"More than half of the physicians who used the handhelds reported avoiding at least one medication error per week," says Curry, who lauded the program's champions, emergency medical physicians Martin Ogle, M.D., and Mark Thomas, D.O.
The physicians at Prime Health, a 30-physician group practice owned by 374-bed Lake Hospital System in Painesville, had been losing money for five years and were beginning to lose patience and patients. Last year, the system recruited Executive Director Donna Casey, who had spent 22 years in hospital administration and medical group management. Casey, who holds a master's degree in business and led financial turnarounds at two other group practices, began a program to focus on better fiscal management and patient satisfaction.
After attending a program at the International Council of Quality Care in Boca Raton, Fla., Casey and Donald Goddard, M.D., Prime Health's medical director, developed a cost-reduction strategy to cut losses and gain financial control of the company.
Casey says that was accomplished by redesigning physician offices to establish individual doctor-led care-delivery teams.
"The driving goal is to get the patient in as soon as possible to see the doctor," she says, by reconfiguring offices, adding phone lines and exam rooms, hiring receptionists and nurses working exclusively for individual doctors, and reducing delays or impediments to physician-patient visits. Other changes included having doctors dictate diagnoses, condition reports and prescriptions in front of the patients instead of at the end of the day, clarifying directions and saving administrative costs.
"Our doctors have seen a 40% increase in the number of patients, and both the patients and doctors love it," Casey says.
She predicts practice losses, which topped $5 million in 2000, will dip below $2 million this year and reach break-even by July 2002.