19 May 2012

Model of Care Phoenix used featured in the New England Journal of Medicine

It has been almost a year since Health PEI decided not to consider a pilot scheme to keep the Phoenix Medical Practice going.  Since then, no progress has been made in PEI with collaborative care for family doctors.  However, the predicted financial problems have begun to bite with announcements of the needs for large cuts in health spending in real terms.

At the Phoenix Medical Practice, we developed a model of care in which the physician was helped by Practice Nurses and Health Care Technicians who prepared patients to see the doctor, documented the encounter, and prepared prescriptions, tests, and referrals that the doctor recommended.   The Practice Nurses and Practice Pharmacist also saw patients for chronic disease reviews, lifestyle advice, and medication reviews.

This week The New England Journal of Medicine 200th Anniversary Article is "The Evolving Primary Care Physician"* written by clinical assistant professor of family medicine at Georgetown University School of Medicine, Washington, DC.

The article discusses the rise of technology and data collection as a large part of family practice and described a project sponsored by the American Board of Internal Medicine Foundation.  

"I think two thirds of many physicians' days are spent on documentation, administrative tasks, paperwork completion, rote inbox management, data gathering, and data entry", says Dr Sinsky, one of two physicians carrying out the project.

The article continues: "Sinksy noted that some innovative practices have responded by assigning much of the responsibility for data entry to other staff members.  For example, on one more collaborative model of care, a nurse or medical assistant accompanies the physician on each visit and enters the finding and treatment plan into the computer, and prepares prescriptions and instructions for the patient."

It then goes on to describe a solo internist in North Carolina, Dr Douglas Kelling, who developed a team-based model for his practice that involved two physicians, six physician assistants, two pharmacists, and other team members such as a case worker and discharge planner.  He was able to greatly increase the number of patients he was able to care for the and improve the quality of that care.

So, we now have validation of the precise model we developed for PEI.  From a respected professor of Primary Care at one of the most respected medical schools in North America, writing in the world's most prestigious medical journal.   That model is now being developed and expanded elsewhere in North America and is being held up as the future of primary care.  That model was already working on PEI, could have been expanded easily, and would have saved large numbers of lives and dollars for PEI.  It would have put PEI on the map for being at the cutting edge of primary care, not just in Canada but in North America.

The effects of the loss of the Phoenix Medical Practice and it's successful model of care will continue to be felt in PEI for decades to come.

* "The Evolving Primary Care Physician", Susan Okie, M.D., New England Journal of Medicine, May 17, 2012, Vol 366, No 20

19 September 2011

Office Now Closed

The Phoenix Medical Practice is now closed.  The office has been vacated, and our Electronic Medical Record system has been transferred over to Health PEI.

Patients looking for copies of their medical records should contact Health PEI.

01 June 2011

Patients want collaborative care

The Island Health and Patient Advocacy Association are asking the government and Health PEI to continue to provide them with a collaborative medical practice, as reported by CBC news.

It is great to see that patients are seeing the benefits of being looked after by an integrated team of professionals.

Phoenix Medical Practice's management team are preparing an updated pilot proposal which would see the practice continue with a team of doctors.   They are looking at how much input they will need from Dr Coull for this to happen.  They will also be contacting the Medical Society to inform them of recent developments.

31 May 2011

New Patient Advocacy Group formed for PEI

The Island Health and Patient Advocacy Association has launched its new website.

"The Island Health and Patient Advocacy Association (IHPAA) is dedicated to positive change in the PEI health care system through reasonable, responsible and respectful philosophies and methods."

We are delighted to see a Patient Advocacy Group formed on PEI.  This is a huge step towards improving health care for patients on the island.  The Island Health and Patient Advocacy Group will give patients a voice.  It empowers patients.  It allows patients to engage with government and ask important questions about how health care is being provided.

Visit the Island Health and Patient Advocacy Association if you would like to get involved.

26 May 2011

Cost comparison

This is a cost comparison of the Health PEI units at Four Neighbourhoods Community Health Center (4NCHC) and Hunter River compared with the Phoenix Medical Practice.

4NCHC and Central Queens are Health PEI-run Community Health Centres.  Like Phoenix Medical Practice, they were set up to run as modern collaborative medical practice providing family health services through a team of health care professionals.

The 4NCHC and Central Queens figures are our estimates, but we'd be happy for Health PEI to provide corrections from their own figures.

Health PEI
Four Neighbourhoods
Health PEI
Central Queens Community Health Centre
(Hunter River)
Phoenix Medical Practice
Year Openedaround 2002around 20022009
# Patients1,75019004,500
# Doctors2.2 full time equivalents2 full time equivalents1 full time equivalent
StatusNever functional.
Nursing services never developed.
All the doctors left 4NCHC in 2010
but staff remain in post.
Limited success
via Nurse Practitioner
Fully functional
Collaborative service
Extended opening hours.
Wide range of services.
Funding / year

$1 million estimate$765,000 estimate$600,000

$535 (in 2010)$403$133

One of the figures is the 'cost per patient per year'.  That's one of the two key things you need to look at to work out if you are getting value for money in health care: the cost.  Phoenix Medical Practice was $133 per patient per year.  I estimate Health PEI's centres were around 3 to 4 times that amount: up to $535 per patient per year.

The second key thing you need to look at to see if you are getting value for your health care dollars is quality.   Health PEI's 4NCHC was never really functional.  After around 10 years of trying to get the collaborative system working properly, the last doctor left 4NCHC in 2010.   The Phoenix Medical Practice, on the other hand, was fully functional.  This functionality included quality systems to keep people healthy longer (great for patients, but also keeps the hospital bill down for taxpayers), and systems to measure that quality.

This enabled the Phoenix Medical Practice were able to provide evidence of quality care and low cost per patient.

20 May 2011

Phoenix Medical Practice to close

We have recently learned that Health PEI will not be providing the additional funding we requested in order to stay open. We are therefore very sad to announce that the Phoenix Medical Practice is closing with immediate effect. 

Download the full press release.

Information on services still available.

How to obtain a copy of your records

What happened?
It was always going to be difficult providing high-quality modern health care under the old 'fee-for-service' model.   We were only receiving half the funding per-patient per-year of a salaried doctor, so we never made a profit from fee-for-service.    Initially we used the 'Patient Access' pilot which is open to all PEI doctors - this paid us a fee for taking on new patients.  However, this was still not enough funding to attract a second doctor.  

But we knew we were doing a lot of the right things.  We cost less money than traditional practice per patient per year.  We were keeping people out of hospital with our prevention services.   And Health PEI had described us when they described their vision for the future.  So we put together an offer of a pilot.  The Medical Society were supporting us, and Health PEI seemed very interested.   It was quality care, a doctor for every islander,  it was going to cost less per patient per year,  and it was going to save them money elsewhere as well.  We were asking for $7 per patient per month extra funding to keep us open over the next six month until we could get the pilot set up.

It seemed like a great offer.   Quality car for more patients for less money.  So we were very disappointed when they said 'no'.

Could I have stayed on as a 'regular' doctor?
Yes, but it's not an attractive option.  I'd still have to lose all my staff (except say one receptionist and a half-time nurse).  I'd have to let go about 80% of my patients.  I'd have to reduced the quality of the care we were able to provide.  I'd might have to give up my license as a doctor in the UK because the General Medical Council which regulates doctors in the UK would not accept my work in the PEI health care system towards my revalidation.  I'd need to work around two months each year back in Scotland to retain my license.

Download the full press release. 

Phoenix Medical Practice Budget Spreadsheet
Download a copy of our practice budget spreadsheet.   This complex spreadsheet contains the costs and projected income for various different possible set ups.  It is saved as our current budget for 1 doctor with the province covering 50% of the nurse billing values, showing a loss of $55,000 per year.  Changing the number of doctors to 3 and the percentage of the nurse billing covered by the province to 100% will give our original business model which is what we based our pilot proposal on.  Health PEI had one of their financial officers go through this spreadsheet and they met with us to discuss it.  They agreed the figures were reasonably accurate.

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