When Dr. Tom Stotz, owner of Yankton’s First Chiropractic Centers found out a couple of years ago that his clinic could improve patient care, satisfaction and reduce costs through better utilization of the electronic health software his clinic uses, he was ready to sign up.
The work that First Chiropractic accomplished since then was noteworthy, and garnered the clinic an invitation to attend a national conference hosted by the Centers for Medicare and Medicaid Services in Baltimore earlier this month.
Stotz’s quest to better serve his patients led him to contact HealthPOINT, a non-profit group affiliated with Dakota State University (DSU).
“We went to them and asked if we could be part of what they were doing with the practice transformation networks so that we could make sure we were giving the highest quality care, with the best patient satisfaction, with the least cost to the system,” Stotz said. “That is what the triple aim of the program is about.”
HealthPOINT was established through a grant from Iowa Health Care Collaborative and is part of Compass PTN, a Practice Transformation Network (PTN) whose goal is to improve patient care by providing technical assistance, guidance and information on best practices to health care providers.
“We go to clinics and help providers with the ‘quality transformation,’” said Tara Leonard, project manager for North and South Dakota and clinical IT lead for HealthPOINT. “Basically, we are (making) the change of going from volume based to value based.”
The goal is to get health care professionals to understand and use their Electronic Health Record (EHR) to its fullest capacity. The EHR software contains “quality metrics,” or tools used to measure the quality of the healthcare process and outcome, as well as patient perceptions, to deliver high-quality care.
“How you measure value is through the ‘quality metrics’ through the EHR that we take a look at,” Leonard said. “We educate them on pulling those reports, looking at those reports, validating the data, looking at how to interact with patients and educate patients.”
Understanding the software’s full capabilities enables physicians to ask specific questions meaningful to their patients and get responses in the form of data that can be used to make treatment and care decisions.
“Looking historically, we were the first practice to be recognized as a patient-centered connect care through the NCQA (National Committee for Quality Assurance) accrediting organization, so a lot of the quality measures, we were already doing,” Stotz said. “What Tara and her group helped us do is identify a single pathway that we could travel through, measuring all of our patients 65 years and older on their risk of falling, and then putting together a program that those people could then go through and try to get them rehabbed into a better position where their balance is better.”
The rehab program was developed by First Chiropractic and is done with in-house physical therapist Kari Schoenfish, who helped set up the program.
“We have a couple of evaluation tools that we look at: how much they are at risk, like, what their score is. It takes into play their age and male versus female,” Schoenfish said. “Then we go into a strengthening program, strengthening their core muscles — a lot of balance comes from core muscles — with exercises they can do at home or in their bed, because most of these patients aren’t going to be getting on the floor.”
After a month, the patient’s risk of falling is reevaluated with specific evaluation tools.
Another success of the partnership between HealthPOINT and First Chiropractic is the transmission of a report of each visit to a patient’s primary-care physician.
“It’s always been challenging to incorporate not only chiropractic into the primary-care world, but specialty care into the primary-care world,” Leonard said. “Now with the opioid epidemic, there are so many other resources that these chiropractors can (use) to treat that patient as a whole.”
In 2017, First Chiropractic received a “high performer” grade on its use of the EHR software.
“They were deemed an exemplary practice,” Leonard said. “We shared their story with Compass PTN, and they said, ‘Let’s invite them to Baltimore to the Centers for Medicare & Medicaid Services (CMS) Quality Conference in February.”
At the conference, Stotz met Dennis Wagner, the director of the Quality Improvement & Innovation Group at CMS and was able to share about the challenges of the chiropractic community to meet their expectations, namely that evaluation and management are still considered out-of-pocket expenses.
Stotz said that though he hopes to have planted the seeds of change with Medicare and Medicaid at the conference, his work to continue to up the level of care his patients will continue.
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