Management of Health Systems PGYIII

Description of Rotation or Educational Experience

The Management of Health Systems Rotation is a two-week rotational experience completed during the both PGYIII year of training. The overall goal is to develop the knowledge and skills necessary to manage various components of a practice that include organization, administration, communication, marketing and patient care aspects. 

The rotation is designed to allow each resident an opportunity to experience practice and community functions that they otherwise may not have direct experience with during their residency.

Goal I: Provide the resident the tools necessary to evaluate future practice.

Goal II:  Provide the resident the tools necessary to operate and manage a primary care office.

Goal III: Provide the resident with the tools necessary to find specific employment opportunities.

The resident will:

• Meet with the Associate Director for AHEC Northwest to discuss the financial aspects of running a practice.
• Meet with the Dr. Danny Proffitt to discuss various types of practice opportunities.
• Meet with the Nursing Manager of the Family Medical Center to discuss staffing needs and personnel management.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.  Residents are expected to:

Competencies

·    Maintain a balance between patient advocacy and the successful model, pertinent to the practice (private practice, CHC, urgent care clinic, etc.).

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to:

Competencies

• Identify strengths, deficiencies and limits in ones knowledge and expertise.
• Locate, appraise and assimilate evidence from scientific studies related to their practice standards.

Objectives

• Identify his/her personal issues, priorities and values and describe, in general, the sort of practice situation and lifestyle that will most closely match those values and priorities.
• Analyze office work flow patterns.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

Competencies

• Work effectively in various health care delivery settings and systems relevant to Family Medicine.
• Have a working knowledge of the interdependence of staff in an office practice. 

Objectives

The resident will:

• Describe the advantages and disadvantages between various practice models including, but not limited to the following:
  • Solo practice
  • Single specialty groups
  • Multispeciality groups
• Describe the difference between various medical financial models including:
  • Health maintenance organizations, including both open panel and closed panel or staff model HMO’s
  • Independent Practice Associations (IPA’s)
  • Foundation model clinics
  • Partnerships
  • Hospital owned or sponsored organizations including Physician-Hospital Organizations (PHO’s) and Management services Organizations (MSO’s)
  • Employer owned or sponsored medical practices
  • Public sector health care providers including federal (military and US Public Health Service), state and local health departments, federally funded community health centers, migrant worker, or nonprofit health centers, university health centers, and public hospitals.
  • Academic institutions including medical schools (both public and prove) and private community-based residency programs.
• Define the various potential elements of physician compensations and determine which apply for any given practice opportunity. Elements to consider include;
  • Salary, incentives and revenue sharing
  • Shared risks, profits, costs and captitated risks
  • Equity and partnerships: buy-in and buy-out
  • Fringe benefits, Malpractice, Retirement, etc.
  • On-call responsibilities
  • Vacation, CME and sick leave/disability policies
• Define the term “managed care” and distinguish how it differs form standard fee-for-service medical reimbursement
• Define basic terms used to describe elements of managed care, including (but not limited to) the terms” coinsurance, so-payment, concurrent utilization review, carve-out, drug formulary, participating provider, and per member per month (PMPM).
• Outline the steps necessary to apply for licensure, hospital credentials and insurance provider numbers.
• Describe the essential elements of proper coding
• Define the computer needs of a given practice setting (billing, scheduling, result reporting, electronic medical record, etc.)
• Define marketing strategy and patient retention techniques using ethical marketing goals.
• Describe the scope of practice; range of activities, and patient mix desired in future practice situations.
• Decide whether or note to perform obstetrics
• Delineate those procedures that will be performed in his/her future practice.
• Determine what level if any, of academic activities are desired I practice.
• Identify specific practice opportunities
• Prepare a curriculum vitae (CV)
• Evaluate a managed care contract and determine whether the conditions are favorable
• Define basic terms used to describe elements of managed care, including (but not limited to) the terms” coinsurance, so-payment, concurrent utilization review, carve-out, drug formulary, participating provider, and per member per month (PMPM).
• Describe his or her malpractice insurance needs (including coverage limits, occurrence v. claims-made policies and tail coverage and coverage for obstetrics, special procedures and moonlighting).
• Explain self-referral and antikickback (Stark) regulations
• Describe those laboratory regulations that pertain to any give practice situation
• Describe restrictive covenants or non-competition clauses
• Define the duration of any potential employment contacts, as well as the conditions of renewal and terminations.
• Describe the basic financial and accounting principles required to manage a primary care office including financial reports, cash flow, billing and collections and overhead management.
• Describe the basic tenants of managed care contract negotiations
• Define ancillary service needs including laboratory, x-ray, other diagnostic services, pharmacy, and medications.

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others

Objective

• The resident will be possession of a demeanor identified by staff as a leader and resource.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to:

Competencies

• Demonstrate understanding of the principles of personnel management required for a given practice situation including but not limited to development and communication of performance standards and review mechanisms.

Objectives

• Discuss the steps to successfully hire nurses, office staff and etc.
• Give effective feedback to employees.

Teaching Methods

“Medical Practice Management: Transitioning to Success” CD-Rom with the goals of teaching residents the skills and knowledge that are necessary to lead their medical practice to success, to enable residents to make the necessary decisions regarding personnel, finances, and practice set-up for exemplary patient care, and, to accomplish long term financial stability and success. The residents will be provided supplemental suggested readings, meetings with AHEC staff and faculty as well as local experts on practice management issues, observation opportunities, and site visits.

At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations’ supervising physician.  When the completed evaluation is returned, the resident physician and the resident’s faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form.  Next, the program director reviews and attests to the document.  Once all three have reviewed and attested the evaluation, it is included in the resident’s permanent file. 

Each resident is asked to evaluate the rotation and supervising physician(s) at the end of the rotation.  The resident’s faculty advisor and program director review the evaluation and attest to reviewing it by signing/initialing the form. These evaluations are filed together by resident year.

The resident is supervised by Dr. Danny Proffitt.

Educational Resources

Given to resident at the beginning of the rotation.

“Medical Practice Management: Transitioning to Success” CD-Rom