OFM III

Outpatient Family Medicine III

This is a one-month rotation during the first half of the third year with Dr. Beckstead as the the coordinator.

Objectives: By the end of Outpatient Family Medicine III, the resident will:

1. Organize and conduct an efficient outpatient visit, creating and sustaining a therapeutic and ethically sound relationship with patients.

(Skills, attitudes; Interpersonal and Communication Skills)

Instructional methods.

a) Discussion of videotaped interactions with the Behavioral Scientist.

c) AFP office hours five or six half days a week.

2. Accurately, completely and efficiently evaluate patients by phone, discerning those who need to be seen that day and giving accurate advice to those who do not need to be seen. (Knowledge, Skills, Attitudes; Patient care, Medical knowledge, Professionalism)

a) Monday from 8:00 am to 9:00 will answer and document calls from patients wishing to be seen. The rest of the morning will see sick call.

b) Triage resources/books to AFP library.

3. Explore the business practices of a variety of family practice settings. (Knowledge, Attitudes; Systems-based practice)

a. Visit area practice(s) to view different ways of billing, scheduling and organization of business practices.

4. Code and bill complicated inpatient and outpatient family medicine family medicine visits, procedures and tests accurately and efficiently. Understand the interplay of insurances and billing.

(Skills; Systems-based practice)

Instructional technique:

a) Readings, discussions and chart audits.

5. Evaluate practice plans, compensation systems and contracts.

(Knowledge, Attitudes; Systems-based practice)

Instructional technique:

a. Analyze typical contracts and examples from the resident's experience. Discuss with Dr. Beckstead or advisor.

6. Analyze practice experience and perform practice-based improvement activities using a systematic methodology.

(Knowledge, Skills, Attitudes; Practice-based Learning and Improvement)

Complete quality project. Present to the next AFP CPI Committee meeting and at FP Rounds.

Altoona Family Physicians

Management of Health Systems Curriculum

Competency-based Goals and Objectives

Curriculum description and general goals:

The Management of Health Systems curriculum is longitudinal and extensive. It is primarily integrated into the three outpatient family medicine months (COFME-I, II, and III). Residents are assigned to meet with FMC business office staff for at least one half day in PGY-1 year, two half-days in the PGY-2 year, and six half-days in the PGY-3 year. The residents also spend an average of six half-days on COFME-III observing other community practices, and seven or more half-days designing and implementing a CPI (continuous performance improvement) project during the three COFME rotations. In addition, residents will spend two half-days working with a community retail pharmacist, and one hour of one-on-one coding with the Program Director followed by several hours of self-study and a coding quiz.

Additionally, during their PGY-2 year all residents are required to attend a two full day practice management seminar given at ARHS by Jack Valancy, a renowned lecturer on this subject.

Contracts for future practices may be reviewed at any time with the Program Director or other faculty.

Each month the Program Director or his designee runs an FMC business meeting which residents are required to attend. Much of the teaching of the management of health systems curriculum occurs during those meetings. Every other month the entire staff attends the meeting, and in the alternate month select staff members are invited to discuss topics and teach. Occasionally guest speakers are also brought in to teach about risk management, malpractice, leadership, media, medical staff issues, practice law, and similar topics.

Competency 1: Patient Care: 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:

All Residents:

Develop time management skills to improve office efficiency.

Use knowledge of coding to appropriately code and bill FMC patient visits which will be audited by office preceptors

Competency 2: Medical Knowledge: Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

All Residents:

Spend a one hour session with the Program Director learning one-on-one office visit coding, then analyze six coding cases and subsequently compare assessments with those of the �Family Practice Management� journal experts. Residents will also attend other noon conferences and business meetings where inpatient and other coding are taught.

Become aware of different malpractice types, and list the advantages and disadvantages of �occurrence� vs. �claims-made� insurance policies. Residents should also learn the typical limits of coverage and what they mean, as well as strategies to protect personal assets in the event of a suit.

Meet for several � day sessions with the billing personnel at both FMC�s to explore patient and staff scheduling, staffing, insurance information, billing, office policies, personnel management, telephone triage systems, electronic records, financial reports, credentialing, accounting, and other office issues.

Attend monthly mandatory business meetings, at which topics such as insurance reimbursement, pay for performance, managed care, reimbursement, RVU�s, office budgeting, staffing, practice law including HIPAA regs, risk management, leadership, customer satisfaction, dealing with media, and practice financial analysis will occur.

Learn malpractice prevention strategies which can be implemented in future resident practices.

Attend a 2 day seminar during their PGY-2 year given by Jack Valancy on various practice management topics including setting up a practice, valuing a practice in the marketplace, and impact of new technologies on practices.

Review the folder of practice management articles which is constantly updated by the Program Director. Various assistive devices such as coding organizers may be copied and used in resident practices.

Visit local and regional offices to explore the various types of medical practice.

Spend two half-days with a local retail pharmacist learning third party issues, medication dispensing, pharmacy law, physician prescribing habits, and related topics.

Competency 3: Practice Based Learning and Improvement: 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 meet the following goals:

o identify strengths, deficiencies, and limits in one�s knowledge and expertise;

o set learning and improvement goals;

o identify and perform appropriate learning activities;

o systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement;

o incorporate formative evaluation feedback into daily practice;

All Residents:

Learn to create systems to minimize system errors in office and hospital medical practices. Resident membership on hospital committees provides opportunity to use these developed skills for actual improvement of the ARHS.

Learn to use an electronic medical record by first hand experience at the FMC�s; Residents may also explore alternative systems at local practices. Residents may use input from preceptors and audits to improve their office care. They must also design and implement one CPI (continuous performance improvement) project during their three years, ideally started on the COFME-I rotation, designed in detail and implemented during COFME-II, and completed and analyzed with a final outcome and plan during the COFME-III rotation. These projects may be on any office or similar issue, but must be approved by the Program Director. Ideally many of the projects will use analysis of AFP and/or WFP FMC data for the improvement of those offices.

Competency 4: Interpersonal and Communication Skills: Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to:

All Residents:

Give constructive input to the FMC staff, faculty, and other residents regarding the management of system issues discussed at the monthly AFP/WFP business meetings.

Discuss specific educational desires with management personnel regarding practice management issues when exploring local and regional office practices.

Competency 5: Professionalism: Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

All Residents:

Explore and develop personal time management strategies.

Attend noon conferences given by local leaders on leadership skills, and develop methods to include these skills in future practices and communities.

Analyze feedback received from preceptors regarding coding and billing to improve accuracy of coding and billing FMC patients.

Competency 6: Systems-Based Practice: 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:

All Residents:

Learn to design and analyze an office budget, including personnel, capital, and supplies and expense categories.

Understand methods to promote a medical practice in a community.

Understand methods to market one�s practice in a community.

Learn tactics to use the local media to provide information to your patients while also marketing your practice. Residents should become aware of the dangers of miscommunication with or misinterpretation by media representatives.

Understand staffing requirements in various types of practices by reviewing these criteria at noon conferences, with experts, and with local and regional office business managers.

Understand the set up of an ideal office practice, and explore the alternatives present in the local and regional community by visiting these practices and discussing with management personnel.

Understand the purpose of various forms used in office practices, including advanced beneficiary notices, advanced directives, narcotic contracts, insurance billing forms, encounter forms (paper and electronic), disability forms, and various forms required by patients in order to drive, work, etc.

Review actual potential practice contracts with the Program Director or other faculty, and analyze both the typical and atypical provisions.

Spend time with a retail pharmacist learning how prescriptions are filled and related insurance company and formulary issues.

Learn the advantages and limitations of medical organizations such as the AMA, AAFP, and local medical societies.

Learn the mechanisms for handling office no-shows and dismissal of patients, including the reasonable reasons for dismissing a patient, and use this knowledge in the FMC.

Educational Resources:

All residents are required to review a folder of varied and pertinent practice management articles kept current by the Program Director.

www.aafp.org/fpm

�The Complete Practice Management Seminar Handbook� is distributed in the PGY-2 year by Jack Valancy.

Go to Curriculum page