In primary care, the concept of patient engagement has emerged as a key driver of improved patient outcomes. Imagine a scenario where every patient not only leaves the clinic with a treatment plan but also with a clear understanding of their role in their health journey.

The business of primary care is a serious one and a unique one. Maybe you’ve always known you want to be in healthcare and primary care specifically, or perhaps you’re one of the many who, to use the Napoleon Hill term, “drifted” into your current role. However you got to where you are right now, what you and your practice do to serve your community is critical.

Health equity has become a topic of increased awareness and interest in the last several years, and CMS has most assuredly taken notice. Before you think that this is not my practice, not my concern, and not something I have to worry about, it’s best to be informed of what health equity is, what CMS is doing about it, and why health equity matters at your practice.

The Dictionary defines leadership as “the action of leading a group of people or an organization”. There are a variety of interpretations of what it means to be a leader but I would like to expand on this and create a definition of the word specific to the primary care setting. Leadership in primary care is “the action of inspiring, encouraging, and empowering a team of people to work together to provide high quality care to their patients resulting in positive outcomes and strong interpersonal relationships”.

With the public health emergency and the impact of Covid on the overall workforce, we’ve all become even more familiar with terms such as “The Great Resignation” and “toxic culture”. Especially in the overburdened healthcare industry, with many clinical and support areas experiencing shortages of employees or shifts in employee responsibilities, the topic of workplace culture has become even more critical.

Does the culture of a practice impact the quality of care a patient receives? Research shows it does. It is well known that engaged employees are more productive and have greater job satisfaction. Let's look at how culture can help an organization achieve higher quality care for their patients. According to Merriam-Webster, culture is "the set of shared attitudes, values, goals, and practices that characterizes an institution or organization". If a practice is solely focused on volume and revenue with no regard for the providers and team, the result is likely a negative culture with burnout and high turnover rates.

The Great Resignation is a term with which we as society are all too familiar, and physician practices are definitely not exempt from the sting of The Great Resignation. Throughout the pandemic, healthcare workers (among others) were heralded as heroes, with many public displays of support and care as we all banded together to get through something none of us have ever seen before. Doctors, nurses, and practice staff were showered with support and kindness, sent letters and cards, and were generally appreciated.

Imagine this.

You’re in a new city for a trip, and have checked in to your hotel for the stay. It’s close to dinner time, and you are ready to go out and eat. What do you do? If you’re like most people, you’ll open up one of many websites or apps, such as Google, Yelp, Facebook, or others, and search for dining options near you. You’ll likely look at which ones are the closest options, then see what type of restaurant strikes you.

Medicare Annual Wellness Visits (AWV) are frequently viewed by primary care providers as a tedious visit in which patients see little value. With consistent access to care issues and a shortage of primary care providers, these visits are easy to push to the side and focus on other visits. The problem is, these visits can impact attribution and they are also a key metric in value-based care plans as well as Accountable Care Organization (ACO) requirements to receive incentive payments. So how can a practice balance the need to maintain attribution and satisfy insurance requirements while still providing crucial hands-on care to patients? The answer may be more simple than hiring more providers or limiting new patients. Nurse-led Annual Wellness Visit programs have been proven to effectively meet the AWV requirements while increasing access to the provider for other visits.

Work smarter not harder is a phrase often heard in many settings, not just healthcare but what does that mean in the primary care world? How can we work smarter not harder when there is so much work to be done?  Change in any form can be difficult and scary, especially when it involves new technology.  Finding the right solution and gaining buy-in from providers and team members can be the most difficult part of this process even if the solution will make their job easier.  The key is to engage the affected team members early on, share the vision, acknowledge the loss of the old way, and give them opportunities to participate in the process.

You as a primary care leader are responsible to your practice and yourself for financial performance. As value based care evolves for your Medicare patients, this performance is becoming more directly linked to stars performance. There are value based care programs available from CMS directly, as well as payer-specific value based care incentives that your practice might qualify for. There are also basic, upside-only contracts from both entities and more advanced, risk-bearing contracts as your practice matures and can gain through these more advanced contracts.

Primary care, and the leaders, physicians, clinicians, and support team within those primary care offices, are truly at the heart of making healthcare better. As we close out 2022 and enter 2023, there is no better time to focus on something that’s often overlooked in the business of primary care - you and your intentions.

It seems everywhere you look now, self-service is present from self-check-outs to ordering and paying using a QR code at a restaurant. Self-service, or the digital front door, became even more prominent with the COVID pandemic to reduce face-to-face interactions and the spread of the virus. Healthcare has had self-service options for patients for some time now through patient portals but these options are continually expanding to allow patients to interact with their healthcare team in the way they prefer. These methods can include self-scheduling, text messages to request an appointment or change an existing appointment, paying bills, completing health assessments before arriving at the office, and checking in for an appointment prior to arrival.

The Institute of Medicine defines primary care as “the provision of whole-person, integrated, accessible, and equitable health care by interprofessional teams that are accountable for addressing the majority of an individual's health and wellness needs across settings and through sustained relationships with patients, families, and communities”. To align insurance carriers, healthcare providers, and patients’ perception of quality healthcare, the first step is to build relationships among the three entities through more collaborative communication.

Merriam-Webster defines quality as the “degree of excellence”. So how do we define the degree of excellence in healthcare? What does quality healthcare look like? This answer can vary depending upon who is asked the question.

Over the past 40 years, we've seen a large shift in primary care and the United States healthcare system. Unfortunately, the changes have resulted in a very broken system, and we now more than ever see the need to correct the flaws.

Data in healthcare is now essentially ubiquitous: there are mountains of it everywhere. With the promise of tech and big data, healthcare systems snapped up technology that promised to capture all their data and provide enhanced and unprecedented insights. EHRs were pushed on physicians, claiming better data collection, organization, and utilization.

From the FFS perspective all these yearly patient evaluations add revenue at a relatively higher rate than a typical office visit. A Medicare AWV generates the same work RVU rate as..

A misconception exists that physicians must choose between practicing fee-for-service (FFS) medicine and Value-based Care (VBC). We often hear the phrase "a foot in two canoes" to represent the perceived need to abandon one watercraft for another identical one in their move to VBC, the notion being you can't simultaneously be in both payment models, and you need to choose. This perception can be paralyzing when considering making a business move within one of these practice / delivery models.

ACP is a face-to-face service (including telemedicine) where a patient and their physician discuss the patient’s health care wishes should they become unable to make decisions about their care. Things like advance directives and Health Care Proxies are discussed. [You can generally find ADs on your State attorney generals’ office website.]