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Is Smaller Better? The "Micropractice" Model of Primary Care
A Wall Street Journal article (Feb. 23) reports on "micropractices"—small group or solo primary care practices that keep overhead costs at a minimum and use information technology to streamline administrative processes and help them focus on patient care. The ideal micropractice model was developed by Gordon Moore, M.D., a primary care practitioner in Rochester, N.Y., who had become frustrated with the inefficiencies of large group practices and the lack of time he had to spend with patients. Micropractices rely on electronic health records, online patient scheduling, and electronic billing to automate certain processes, leaving them more time to spend with patients. Moore is disseminating this care delivery model with support from the Boston-based Physicians' Foundation for Health System Excellence. Thus far, about 60 physicians have adopted it.

ACP Backs Patient-Centered Care
Fewer medical school graduates are choosing primary care practice, and many current practitioners are leaving the field or retiring. To reverse this "looming collapse," the American College of Physicians (ACP) proposed the advancement of patient-centered primary care in its annual State of the Nation's Health Care report (Jan. 22). Under the patient-centered primary care model, patients play active roles in managing their care and providers offer comprehensive, coordinated services through the use of health information technology and other system improvements. According to the report, this approach results in better quality, more efficient use of resources, reduced utilization, and higher patient satisfaction. A companion report recommended reforming current Medicare physician payments to include payment on a risk-adjusted, bundled, and prospective basis for giving beneficiaries a "medical home," rather than for the volume of services provided.

Joint Commission Recommendations Focus on Communication
In a white paper released Feb. 7, the Joint Commission details 35 recommendations to improve health literacy and thus ensure patient safety. Health literacy—the skills patients need to communicate with providers, read medical information, make decisions about treatments, and carry out care regimens—is an important aspect of patient safety. Breakdowns in these communication processes can result in improper use of prescription drugs, poor management of chronic diseases, and other problems. The white paper recommends ways for health care organizations to prioritize communication, address patients' communication needs across the continuum of care, and pursue policy changes that promote effective patient–provider interactions.

CMS to Make Performance Information Available
On Feb. 15, the Centers for Medicare and Medicaid Services (CMS) announced that it would make information on physician performance available to Medicare beneficiaries as part of its Better Quality Information to Improve Care for Medicare Beneficiaries initiative. CMS will report national, consensus-based measures of performance, using data from Medicare as well as private insurers. In addition to providing health consumers with information about their care, the project aims to test the feasibility of aggregating performance data from multiple sources. The Delmarva Foundation for Medical Care, a quality improvement organization working with CMS on the project, has hired four regional collaboratives to coordinate data collection: the Indiana Health Information Exchange, Massachusetts Health Quality Partners, Minnesota Community Measurement, and the Wisconsin Collaborative for Healthcare Quality. Two additional groups are expected to join the initiative.

Business Group Publishes Guide to Value-Driven Health Care
A business coalition, the Partnership for Value-driven Health Care, published a purchasing guide for employers Feb. 7. Called The Purchaser Guide to Value-driven Health Care, it offers employers help in meeting the HHS Secretary's call to implement "four cornerstones of value-driven health care." These are to: promote the use of interoperable health information technology; measure and publish information on health care quality; measure and publish information on pricing; and create incentives for high-quality, efficient health care. The guide outlines actions employers can take and includes a list of employer initiatives. Thus far, about 175 companies—including the Ford Motor Company, Chrysler Group, and General Motors—have agreed to follow the Bush Administration's guidelines for promoting value-driven health care.

Free e-Prescribing Available to U.S. Doctors
On Feb. 1, free Web-based e-prescribing became available to all U.S. physicians and pharmacies. The National ePrescribing Patient Safety Initiative, a coalition of leading technology companies and health care organizations, is promoting the e-prescribing tool in an effort to improve the accuracy of prescribing and reduce the rate of medication errors. The free software enables online prescribing as well as automated checks on drug interactions, dosage levels, and prior adverse reactions by specific patients. Developed by the Allscripts company, the prescribing software bases its security measures on Drug Enforcement Administration (DEA) and state licensing numbers, as well as physicians' personal information and prescribing habits. The Allscripts tool was in use by about 30,000 doctors commercially, and it was made available at no cost through the sponsorship of Allscripts, as well as companies including Google, Dell, Cisco, Aetna, and Wellpoint.

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