Faculty Chairs
Contacts:
- Joanna Rachelson, MD
- Sarah Summers-Barrio, DNP
Required Experiences:
- Monthly lectures
- Monthly “All Staff” meetings
- Monthly and quarterly hospital committee meetings
- Department of Family Medicine
- Medical Staff
- Graduate Medical Education Committee
- Participation in state and national professional association
- Completion of the self study curriculum titled “From Residency to Reality” published by the AAFP
- Completion of a review of a Resident Productivity Report quarterly with the resident’s faculty advisor
- Completion of a Professional Prospectus for first post-residency year
- Annual “Corporate Compliance” training
Optional Experiences:
Elective practice management month
Schedule:
This curriculum is longitudinal and the components of the curriculum will be covered during all three years of the residency. The program has a monthly and quarterly meetings to discuss clinic, residency and hospital operations at which attendance is required. The curriculum includes a monthly lecture series which covers practice management topics (billing, coding, QI, contracts, EMR, Patient centered medical home, etc…) as well as topics related to health care advocacy in the clinic, at the hospital, in the community and nationally. Additionally, the curriculum includes a self study of a broad range of practice management issues to be completed by the end of the PGY II year. The resident will complete a review of the resident’s productivity with the faculty advisor on a quarterly basis. Finally, during the PGY III year the resident will complete and present a plan for the year following the residency with a Professional Prospectus that includes a statement of purpose and a budget based on the resident’s productivity during their third year and projected productivity during the first year following the residency. This education is supplemented by an optional Practice Management elective experience, where the resident has a more intense immersion in the management of aspects of a health system or systems selected for emphasis in consultation with the resident’s faculty advisor, the program director and the chairs of the MOHS curriculum.
Requirements:
AOA
Practice Management
The program must provide at least twenty hours of structured educational experiences in practice management.
This training shall include:
- Debt management.
- Retirement planning.
- Financial planning.
- Disability insurance.
- Medical liability insurance.
- Risk management.
- Coding.
- HIPAA requirements in the ambulatory setting.
- OSHA requirements for private practices.
- Payer mix and practice overhead management.
- Personnel management.
The program must utilize actual practice financial data to teach the principals of office practice management. At a minimum this must include resident specific practice data from the continuity of care training site.
ACGME
Residents must have at least 100 hours (or one month) dedicated to health system management experiences. (Core)
This curriculum should prepare residents to be active participants and leaders in their practices, their communities, and the profession of medicine. (Detail)
Each resident should be a member of a health system or professional group committee. (Detail)
Residents must receive regular reports of individual and practice productivity, financial performance, and clinical quality, as well as the training needed to analyze these reports. (Detail)
Residents must attend regular FMP business meetings with staff and faculty members to discuss practice-related policies and procedures, business and service goals, and practice efficiency and quality. (Detail)
Description of Rotation or Educational Experience:
Preamble
Management of health systems (practice management) training is a vital part of the residency curriculum, regardless of the mode of medicine or setting the resident chooses after graduation. Residency graduates are faced with an increasingly complex spectrum of opportunities for medical practice, and their understanding of the choices involved is crucial for their future careers as family physicians. Furthermore, most new physicians will experience practice changes as the health care environment evolves, and a broad knowledge of practice management issues in a variety of settings will be needed for the duration of their medical careers.
Practice management is defined as the body of knowledge, attitudes and skills necessary to efficiently lead and continuously improve the multiple elements of care delivery within a medical practice, including compliance with external regulatory agencies and accreditation requirements. Management of health systems integrates these practice elements into the context of health system organization, administration, communication, marketing and, more importantly, the establishment of a patient centered medical home for patients.
Although the future family physician may delegate many aspects of practice management to other staff and consultants or may, in fact, be a salaried employee of a large organization, an understanding of management of health systems (practice management) is still critical. This knowledge will assist future family physicians when making appropriate personal choices and when fulfilling the ethical responsibility to advocate for the highest standards in delivery of patient care. Furthermore, legal liability for many aspects of patient outcomes continues to remain with physicians even if they are part of a larger organization.
Patient Care
Goal
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.
Competencies
- Advocate for the patient’s welfare while balancing the business realities of practice management and financial success.
- Utilization of available resources to enable underserved populations to obtain care
Objectives
- Describe a practice that balances patient care and business realities
Knowledge
Goal
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.
Competencies
Objectives
In the appropriate setting, the resident should demonstrate the ability to apply knowledge of:
- Practice opportunities
- Location
- Part of the country
- Size and type of community
- Mode of practice
- Traditional solo or group practice
- Urgent care or emergency department
- Staff and group model health maintenance organization (HMO)
- Managed care contracting
- Administrative
- Private industry
- Government
- Education
- National Health Service Corps and Indian Health Service
- Configuration
- Solo
- Partnership
- Group
- Salaried employee
- Corporate management
- Educator
- Employment agreements/contracts
- Compensation and benefits
- Workload and performance expectations
- Professional liability coverage
- Legal provisions
- Ethical issues
- Location
- Practice facilities
- Location and market analysis
- Design and regulations
- Financing
- Equipment and services
- Inventories and supplies
- Rent, lease or own
- Laboratories and government regulations
- Radiology and ultrasonography
- Special office-based procedures
- Office organization
- Chain of command
- Schedules
- Number and type of support staff
- Computer systems and other technologies
- Supply and inventory management
- Practice operations
- Patient flow and scheduling
- Vendors
- Electronic medical records (EMRs) and chart documentation
- Written office policies and procedures
- Front desk duties
- Insurance and other third-party billing
- Management of pharmaceutical representatives and samples
- Management of phone calls
- Telephone and paging systems
- Advanced planning and timetable for entering practice
- Chart and filing options, retention of records
- Consultation referrals
- Management of patient education
- Clinical tracking systems and preventative services
- 360 degree evaluations of self and staff
- Telehealth
- Office and business management
- Systems-based learning and analysis
- Taxes and insurance
- Estate planning and investment
- Pension plan and/or profit sharing
- Tax considerations and social security payments
- Payroll systems
- Insurance needs
- Personal (e.g., life, disability, health)
- Practice (e.g.,employee benefits, premises liability, overhead, fire)
- Monitoring the business
- Reading financial reports
- Cash flow and lines of credit
- Accounting systems
- Billing and collection principles and policies
- Accounts receivable management
- Financing and capital
- Overhead management
- Personal financial planning
- Budgeting, debt consolidation
- Retirement
- Billing
- Coding and documentation (e.g., how to, and importance of inpatient and ambulatory coding)
- Fee for service
- Third-party payers
- Contracting
- Medicare
- Medicaid
- Capitated contracts
- Medical records
- Storage and filing systems
- Indexing and coding
- Release of information
- Confidentiality
- Audits and tracking
- Types of records (including EMRs)
- Structure of records
- Legal issues, including HIPPA
- Staff and personnel policies
- Employee relations
- Mutual respect
- Salaries and benefits
- Motivation
- Recruitment and retention
- Terminations
- Evaluation
- Accountability
- Job descriptions
- Labor laws
- Personnel records
- Employee relations
- Legal issues
- Refer to Curriculum Guideline on Risk Management and Medical Liability. (AAFP Reprint No. 281)
- Computer utilization
- Refer to Curriculum Guideline on Medical Informatics and Computer Applications. (AAFP Reprint No. 288)
- Hospital issues
- Selection of hospital
- Staff appointments and privileges
- Medical staff and departmental responsibilities
- Marketing
- Marketing strategy, ethical marketing goals
- Patient-retention techniques (such as patient satisfaction surveys)
- Resources
- Practice management consultants
- Accountants
- Lawyers
- Financial planning consultants
- Bankers
- Marketing consultants
- Professional relations
- Medical and specialty society involvement
- Community and government
- Interdisciplinary, multidisciplinary and transdisciplinary
- Health care risk contracting
- Quality indicators and reimbursement – relationships with payers and reimbursement.
Skills
In the appropriate setting, the resident should demonstrate the ability to independently perform or appropriately refer:
- Balance personal and professional goals
- Effective leadership skills
- Professionalism
- Determining personal and professional goals.
- Selection of type of practice (involves decisions about lifestyle, residence location and professional interrelationships)
- Position Application
- Career goal setting
- Curriculum vitae development
- Letter of interest (cover letter)
- Identification of available position, recruiters
- Interviewing skills
- Culture and politics of the practice
- Practice configuration
- Single vs. multispecialty
- Associations
- Position Application
- Contract negotiation
- Employment agreements
- Sexual harassment
- Confidentiality
- Requirements as an employee
- Productivity/bonuses
- Teaching opportunities
- Employment agreements
- Prudent selection and utilization of advisors and vendors
- Personnel management and delegation of responsibilities
- Computer competency, including information technologies
- Time management
- Personal and public (oral and written) communication, including advocacy
- Resources management
- Leadership of health care teams
- Adapting to changes in the health care environment (team building and teamwork)
- Networking and collaboration
Practice- Based Learning and Improvement
Goal
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:
Competencies
- Identify the measures of health, including determinants of health, health indicators and health disparities.
Objectives
- Identify a clinic process to improve within the clinic and/or hospital setting
- Perform a quality improvement study with entire clinic to improve patient care and clinic processes
- Analyze data collected and use to improve care of the patient and the clinic or hospital processes as related to the QI project
Systems Based Practice
Goal
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.
Competencies
- Identify the structure and operations of health organizations and systems, and the role of the family physician in this structure.
- Identify and foster partnerships that maximize achievement of public health goals.
Objectives
- Describe personal practice role in the community.
Professionalism
Goal
Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:
Competencies
- Demonstrate knowledge of the legalities and ethics of hiring, promoting and firing of employees in a practice setting.
Objectives
- Model professional behavior with peers, clinical staff, nurses, and administrators
Interpersonal and Communication Skills
Goal
Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.
Competencies
- Actively conduct a practice search, interviews, contract negotiations and successfully enter practice.
Objectives
- Describe the components of meaningful use of an electronic medical record
-
Electronic Medical Records, billing and accounting programs, and electronic filing of claims
Teaching Methods
This component of the residents’ education will be taught in lecture, reading and mentoring formats. An elective rotation is also available.
Assessment Method (residents)
Resident productivity will be monitored quarterly and a report provided to all residents. The residents will also have ongoing billing reviews conducted by the faculty for all clinic billing and by the coders to assure accurate billing. Lastly resident patient numbers are monitored monthly and shared with the resident at the quarterly IEP sessions. Feedback is provided to the residents, at the quarterly IEPs regarding, patient numbers, productivity and accuracy of billing.
Assessment Method (Program Evaluation)
An annual program evaluation will be conducted by the residents during the resident retreat. Also this component of the education will be evaluated by the program graduates on during the annual graduate survey.
Level of Supervision
All resident experiences will be supervised by faculty or community preceptors. Resident productivity will be monitored quarterly and a report provided to all residents. The residents will also have ongoing billing reviews conducted by the faculty for all clinic billing and by the coders to assure accurate billing.
SNMFMRP Curriculum 