JamesLHollyMD.com

	James L. Holly, M.D.

About SETMA Joint Commission Contact Information History Mission Statement Medical Home Scope of Services I-CARE Initiative Infusion Center The SETMA Way - What is it? SETMA's Model of Care Patient-Centered Medical Home The SETMA Approach to Patient Care	In The News Letters Vital Signs - Examiner Publication SETMA's Providers as of January, 2015 SETMA Knows - Abraham Lincoln and Healthcare Analytics SETMA – 1999 – Four Seminal Events PC-PCC Award January, 2015 Vital Signs Spring 2015 Vital Signs Q&A for PC-PCC Award Links to SETMA 2012 eHealth Innovator Award for LESS initiative Handout for Attendees eHealth Conference January 12, 2012 eHealth Initiative 2012 Award Program Application The eHealth Initiative's 2012 Award Letter 2012 National Quality Forum National Healthcare Improvement Award Effective prioritization of performance improvement goals Dashboard to Measure and Manage Whole System Performance Commitment to transparency Date-driven improvement of NQS priorities Demonstration of readiness to assume responsibilities of an ACO Demonstrated results on publicly reported performance measures Public Reporting Quality Metrics for 2009, 2010, 2011 Internally Tracked Reporting Quality Metrics for 2009, 2010, 2011 Complete Application in PDF Format SETMA's Medical Home Pilgrimage 2009 Medical Home Series I 2010 Medical Home Series II 2011 Medical Home Series Two 2009, 2010, 2011 Medical Home Miscellaneous Articles The Dr. and Mrs. James L. Holly Distinguished Professorship Universal American Letter of Transmittal for Support Dr. Holly's Acceptance Address for the 2012 Distinguished Alumnus Award CMS Medical Home Feedback Report Qualify & Cost SETMA questions Influenza Data SETMA I - October 2011 SETMA II - October 2011 Mark A. Wilson Clinic SETMA West - October 2011 SETMA and Fox 4 News - Healthy Living Videos SETMA Advertisements - Display and Video SETMA Announcements Featured Content Archive	Syllabus PC-MH Externship SETMA's MS4 Patient-Center Medical Home Selective Syllabus Introduction to SETMA's Senior Externship and Syllabus An Introduction to the Origins and Beginnings of Southeast Texas Medical Associates, LLP Patient-Centered Communication PC-MH Health Affairs August 15, 2013 Policy Brief -- Health Gap SETMA 8.20.13 Provider Training -- Health Affairs 2.14.13 -- Patient Engagement SETMA Provider Training 8.20.13 during First Senior Medical Student PC-MH Externship Medical Home Coordination Review Tutorial 2011 Medical Home Series Two Teaching Tool for PC-MH Course - Patient Care Activation, Engagement, Shared-Decision Making	Patient Information What Does Patient-Centered Medical Home Mean to You? What Does Patient-Centered Medical Home Mean to You? Health information exchange Patient Rights and Responsibilities Patient Directions Contact SETMA – Secure Texting What is HIPAA? Authorization To Release or Obtain Medical Records Complete Privacy Policy Website Privacy Policy	Presentations Invited Presentations SETMA Provider Training
Governance Board Governance Board Responsibilities Governance Board Leadership Training The SETMA Team and The SETMA Culture SETMA's Mission, Vision and Goals: Patient Safety and Quality Care Harassment, Neglect, Abuse, Exploitation - Role of HCAHPS & CAHPS Healthcare Provider Standards Providers Responsibility Medication Refills, Reconciliation and Maintenance Provider and Leadership Use of Data and Analytics Commitment To All Patients -- Ethnic Disparities Kaizen - Board Creates Culture of Safety and Quality SETMA's Policy and Practice for Advanced Directives SETMA's Policy on Completion of Medical Records Care Guidelines : Improve processes to evaluate and treat Integrated patient safety program (Sentinel Events) Effectively Manages all programs, services or sites Provides Patients with information about Primary-care Medical Home Organization-wide Planning to Maintain Focus on safety and quality Organization-wide Planning to Maintain Focus on safety and quality SETMA's Performance Quality & Safety Judged by CMS SETMA's Performance Quality & Safety Judged by CMS SETMA Awarded by HIMSS for Quality and Safety 2011 John M. Eisenberg Patient Safety and Quality Awards Application Healthcare Quality Award 2012 Principles of Quality and Metrics Principles Contacting SETMA & Secure Texting PC-MH Mission, Vision, Goal, Access, End-of-Life Communications and Public Reporting Change Existing Processes to Improve Performance Team Members Focused on Safety and Quality	Your Life Your Health View Articles by Subject Aging Well Behavioral Health Cardiovascular Disease Risk Care Coordination Care Transitions Children's Health COGNOS Project Diabetes Exercise Healthcare Reform:Public Policy HIPAA & Security Labor Day Less Initiative Medical Home Medical Records Men's Health Mental Health Nutraceuticals Nutrition Smoking Cessation Thanksgiving Weight Management Women's Health All Articles	Public Reporting Public Reports by Year (2009-2017) Public Reports by Type Fall Risk, Pain, Functional, Wellness, Stress Assessment Fall Risk, Pain, Functional, Wellness, Stress Assessment for 2011 AND 2012 Core Measures: SETMA & Baptist Hospital Core Measures for January to December 2011 PQRS Diabetes Measures - Blood Pressure Diabetes Measures - Glyco and LDL Diabetes Measures - Nephropathy Screening, Foot Exam, and Eye Exam Preventive Measures - Screening (BMI, Colorectal Cancer, Mammography, Osteoporosis) Preventive Measures - Influenza, Pneumococcal, Urinary Incontinence Preventive Measures - Tobacco Use NQF Care for Older Adults Comprehensive CHF Care Diabetes Measures Diabetes Measures - Blood Pressure Control Diabetes Measures - Glyco and LDL Diabetes Measures - Smoking Cessation Female Measures General Health Measures Medication Measures Persistent Medications Medication Measures Pediatric Measures HEDIS (NCQA) Effectiveness of Acute Care Effectiveness of Chronic Care - Clinic/Hospital Effectiveness of Chronic Care - Clinic Only Effectiveness of Chronic Care - Diabetes (Smoking Cessation) Effectiveness of Chronic Care - Diabetes (Glyco and LDL) Effectiveness of Chronic Care - Diabetes (Blood Pressure Control) Effectiveness of Preventive Care Effectiveness of Preventive Care - Older Adults Effectiveness of Chronic Care - Diabetes Measures Effectiveness of Chronic Care - Persistent Medications (MPM) NCQA Diabetes Recognition Program Audit LESS Initiative PCPI PCPI Hypertension PCPI Diabetes PCPI Chronic Stable Angina PCPI Care Transitions PCPI CHF PCPI Weight Management PCPI CKD Stages IV V SETMA Lipid Audit Lipids Treatment Audit Tutorial Lipids Tutorial AQA COGNOS Project SETMA Audit for CKD Stages I III Patient Satisfaction Survey	Accreditations/Awards Achievements which have Advanced SETMA: The Time-line, Philosophy and Principles which Underlie that Advancement Awards	Diabetes Center of Excellence Education Diabetes Order Referral Form Seven Stations 2011 Advances in Diabetes Diabetes Tutorial Diabetes Prevention
EPM Tools Association of Medication and Diagnosis Automated Team Function Behavioral Health Adult Weight Management Tutorial Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Behavioral Health in SETMA's Patient-Centered Medical Home Model of Care Depression Tutorial Fall Risk Tutorial Health Insurance Portability and Accountability Act (HIPAA) Privacy Tutorial Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive LESS Initiative Tutorial Medical Home Transtheoretical Model Assessment Stages of Change Tutorial Pain Management Tutorial Reduction of Antipsychotic Medications Toolkit Smoking Cessation Tutorial Stratifying End-of-Life Risk for Hospice Services Tutorial Chronic Conditions Tutorial Chronic Renal Disease Management Tool Tutorial Calculating the Stages of Renal Disease Proteinuria Disease Management Tools Acute Coronary Syndrome Tutorial Adult Weight Management Tutorial Angina Tutorial Cardiometabolic Risk Syndrome Tutorial Chronic Renal Disease Tutorial Congestive Heart Failure Tutorial Diabetes Tutorial Hypertension Tutorial Lipids Tutorial Lipid Quality Audit Tutorial Primary Pulmonary Hypertension Tutorial Framingham Cardiovascular Risk Cardiometabolic Risk Assessment Framingham Heart Study Risk Calculators Tutorial Frederickson Classification of Dyslipidemia LDL Level Lipid Disease Management Risk Assessment General principles about ICD-9 Codes and HCC/RxHCC Codes Charge Posting Tutorial Coding to Ensure Accurate Health Risk Scoring E & M Codes Tutorial HCC & RxHCC Risk HCC/RxHCC Risk Tutorial ICD-9 Code Training Manual Hepatitis Screening Hospital Based Tools Hospital Care Summary and Post Hospital Plan of Care and Treatment Plan Tutorial Admission Orders Tutorial Daily Progress Notes Tutorial Care Transition Data Set from PCPI Tutorial Using The Clinic and Hospital Follow-up Call Templates Respiratory Failure Tutorial Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS): Tutorial for SETMA's Internal HCAHPS Survey Master GP Suite of Templates Master GP Suite of Templates Tutorial Medical Home Support Materials Department of Care Coordination, Director of Care Coordination and Care Coordination Referral Template Electronic Tickler File Electronic Tickler File Tutorial Follow-up Calls Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Services Medical Home Coordination Review Tutorial Medical Home Plan of Care and Treatment Plan Medical Home Transtheoretical Model Assessment Stages of Change Tutorial Patient-Centered Medical Home Annual Questionnaires Patient-Centered Medical Home: SETMA's Medical Home Coordination Review (MHCR) Tutorial Patient Document for Coordination of Care Transitions of Care Management Coding (TCM Code) Tutorial Merit-Based Incentive Payment System (MIPS) Quality Metric Tool Tutorial Nursing Home Depression Tutorial Fall Risk Tutorial Hydration Assessment Tutorial Nursing Home Guidelines for Care Tutorial Nursing Home Principal Suite of Templates Nutrition Assessment Tutorial Reduction of Antipsychotic Medications Toolkit Skin Care Tutorial Outpatient Infusion Center for Intravenous Antibiotic Therapy and Other Meds Preventive Health Tools Adult Weight Management Tutorial CHF Exercise Tutorial Diabetic Exercise Tutorial Diabetes Prevention Tutorial Exercise Prescription Tutorial Hypertension Prevention Tutorial Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Initial Preventive Physical Exam & Annual Wellness Visit Tutorial LESS Initiative Tutorial Progression to Type 2 Diabetes Smoking Cessation Tutorial Progression to Type 2 Diabetes Quality Metrics ACO and Medicare Advantage Stars HEDIS: NCQA, History, Quality, Safety, STARS, ACO ACO Quality Measures Performance Tool ACO Quality Measures Performance Tool Tutorial STARs - A Tutorial for Utilizing SETMA's Deployment of the STARS MA Program Specialized Tools Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Association of Medication & Diagnosis Chronic Conditions Tutorial Chronic Care Management Code (CCM) Tutorial Depression Tutorial Drug Interactions Tutorial Electronic Tickler File Tutorial Evaluation Lower Urinary Tract Symptoms in the Male Fall Risk Tutorial Future Labs Tutorial Hydration Assessment Tutorial HCC Risk Training Tool Hypertension: Fulfilling Quality Metrics for the PCPI Program Laboratory Results - Signing Off: Why and How Medication Module Tutorial Medication Reconciliation Tutorial Nutrition Tutorial Pain Management Tutorial Problem List Reconciliation Tutorial Progression to Type 2 Diabetes Referral Skin Care Tutorial SOAAP Opioid Risk Assessment Stratifying End-of-Life Risk for Hospice Services Tutorial Texas State Reportable Infectious Diseases Tutorial Transitions of Care Management Coding (TCM Code) Tutorial	Transforming Your Practice Library Introduction to SETMA's TCPI Library Transforming Your Practice (TCPI) Summary Document of TCPI CMS Quality 12.2015 TCPI Leadership and Governance Care Coordination HIPPA and Security Data Analytics Care Transitions LESS Initiative Medical Records Clinical Decision Support Hospital Care Tools Disease Management Tools Preventive Health Tools Behavioral Health Transformation Tools New Transformation Tools Patient-Centric Care Nursing Home Medical Home Display and Explanation of SETMA's Patient-Centered Medical Home Tools	Medical Home The Story and the Ideals Introduction to Preventive Health Tools PC-MH Patient Engagement & Alternative Payment Models Preventive Care: The Best Way to Treat Illness is Don’t Get it Coordination of Care Patient-Centric Care Population Health Transition of Care - One form of Care Coordination HCAHPS - Hospital Consumer Assessment Of Healthcare Providers and Systems CAHPS - Consumer Assessment of Health Care Provider and Systems Teaching Tool for PC-MH Course – Patient Care Activation, Engagement, Shared-Decision Making Display & Explanation of PC-MH Tools SETMA's Medical Home Pilgrimage Concierge Medicine not Medical Home Medical Neighborhood Security & HIPPA Referrals Patient Web Portal Health Information Exchange Medication Reconciliation The Automated Team Coordination of Care Medical Home Description & Standards AAAHC Joint Commission NCQA Planetree URAC NCQA Interview February 14, 2014	Facebook	Letters

Letters - Correspondence with Amitabh Chandra defining people to whom we will and will not talk – Remaining a learner even after learning

December 22, 2013

Dear Dr. Chandra:

Thank you for your holiday greetings and to your note of December 21, 2013. I want to respond to your statement, “...what I do say is that I don’t talk to people whose mind is made up and whose views cannot be challenged.” (see full note at the end of this letter) I feel certain that you misspoke and that you don’t mean to say that you don’t talk to people “whose mind is made up,” but that you only don’t talk to people do not allow their “views...(to) be challenged.” To exclude from your conversation mature thinkers whose study and life experiences have led them to firm positions would mean that you refuse to talk to people who know what they currently believe. Hopefully, those whose minds have been made up by years of study and experience, but who remain students and remain “learners,” thus, who delight in interacting with those who will challenge their positions in dialogue, are welcome in your courses. My life experience has taught me that I most often learn more from those with whom I disagree than with simply interacting with people who already agree with me. The only way I know for us to learn is for people who have firm beliefs and positions to dialogue and for them not to have simultaneous monologues where they talk “at” one another and not “with” and “to” one another.

It is very easy to judge people who are highly self-confident as being arrogant and/or as unwilling to allow their views to be examined or challenged. On the other hand, it is very easy for university professors, particularly at prestigious schools of learning, unwittingly to fall into the trap of demanding that others allow their views to be challenged while the professor becomes increasingly unable or unwilling to allow his/her views to be challenged. We all must be lifetime learners, even when we have terminal degrees which affirm great depth and breath of learning.

Several years ago, I invited a Harvard Professor to visit SETMA and to accompany me on a day-long trip through coastal Louisiana. During that visit, we had a great dialogue. At one point he made a declarative statement that he could not imagine an educated person holding certain beliefs. I responded gently, “I believe those things.” At the end of our trip, I said, “Your challenge is that I can be your friend even though we have significant differences about the matters we discussed. The problem is that I suspect that you cannot be my friend if I hold to my beliefs.” Time has proved the validity of my observation. He has not passed the challenge.

I describe myself as a “social liberal, a fiscal conservation and a theological fundamentalist.” Strange bed-fellow, some would say, but totally logical and consisted in my view. In the following letter to CMS (An Appeal to CMS and ONC for a Temporary Exemption to Meaningful Use 2), I described SETMA’s positions on Health Policy and Philosophy with the following observations:

As defined by Don Berwick, we believe that healthcare is a human right.
We embrace the “moral test for government” as defined by Hubert Humphrey in 1977.
The SETMA Foundation was formed in 2009. Annually, SETMA’s partners give $500,000 to the Foundation. These funds are used to pay for the care of patients who cannot afford care and also for support for health education for students who need assistance. These funds cannot profit or benefit SETMA.
In 2003, we initiated a zero-co-pay for our Medicare Advantage (MA) patients to remove all financial barriers to care. We have actually demonstrated a significant difference in outcomes of care between a zero-co-pay-MA population and fee-for-service Medicare beneficiaries. We attribute this to a barrier created by the cost of care for the FFS Medicare beneficiaries.
We have eliminated ethnic disparities in diabetes and hypertension care. (See AHRQ - Diabetes Ethnic Disparities AHRQ letter about ethnic disparities by James L Holly, MD)
To validate our commitment to excellence and transformation in healthcare, we have published our opinions on public health policy at Your Life Your Health - Healthcare-Reform-Public-Policy.
In 2009, we began publishing SETMA provider performance by provider name on over 300 quality metrics at Public Reporting - Reporting by Type.
We provide care for many uninsured and indigent patients and in March, 2014, will assume responsibility for caring for ALL indigent and uninsured patients who come to our largest hospital. This is a practical expression of items 1 and 2 above.
Most of our providers hold adjunct or clinical academic appointments at Texas Schools of Medicine and are committed to life-time learning.

With this foundation, let me illustrate my “learning”.
Setting out to correct and conclude with being corrected

In my February 6, 2003, newspaper column, I wrote the following:

“(Editor's Note: On February 5, 2003, Dr. Holly addressed the Massachusetts Medical Society's Medical Informatics meeting in Boston Massachusetts. Today's article and the next two weeks installments of Your Life Your Health are excerpts from this address which was entitled: ‘Beyond Electronic Medical Records: The Hope and Promise of Electronic Patient Management.’ These excerpts will give The Examiner's readers an opportunity to see the efforts which are being made on a national stage to improve the quality of healthcare in America.)

“Several years ago, I was browsing in a book store, and saw a book with a black fly leaf. I picked it up and it fell open to page thirteen. An interlinear jumped out at me, which stated: ‘Metanoia: -- A Shift of Mind’; The paragraph went on to say, (Metanoia is) the most accurate word in Western Culture to describe what happens in a learning organization.’

“I knew the word metanoia and I knew that it had nothing to do with business. As a Christian and a Bible teacher, I have studied, written and taught that word for years. It is the Greek word for ‘repentance’, and means to ‘have a change of mind or to change one's direction.’ I was absolutely confident that it had nothing to do with American business. In order to "debunk" what the author said, I read Peter Senge's The Fifth Discipline. Needless to say, ‘I had a change of mind.’

“I found in Dr. Senge's book a structural and philosophical foundation for what we were already doing at Southeast Texas Medical Associates (SETMA, www.jameslhollymd.com) in Beaumont, Texas. I also found another illustration of a principle a friend had taught me years before; he said, ‘the person who helps you the most is not one who teaches you something new; it is the person who teaches you how to say that which you already know or suspect.’”

A Learner will grow through mistakes

In a March, 2013 article entitled, “Continuous Professional Development: Learning from a Convergence of Events,” which can be found at Continuous Professional Development: Learning from a Convergence of Events

I said the following:

“Conclusion: Unintentional Neglect of a Patient

“All weekend, I thought and even dreamed about the patient I saw several years ago. Over and over and over, the words rang in my head, ‘I want to lose weight.’ I remembered well that once I had completed the patient’s history and settled on treating her/his diabetes, I unintentionally ignored the patient’s desires. I was certain that the patient had diabetes; which she/he did. And, I was determined to give the patient excellent care; which I didn’t. Rather than explaining to the patient why I don’t treat weight loss with Ionamin, thyroid and diuretics, I just ignored her/his goal.

“Because I ignored the patient’s goal; the patient ignored my plan. As I think of that patient and yesterday, as I and my staff tried to locate the patient without success, I realized that while I would have labeled the patient ‘non-compliant’ using ICD-9, ICD-10, or SNOMED codes for that diagnosis, the real diagnosis should have been ‘failure to communicate,’ ‘non-patient-centric care,’ ‘failure to activate the patient,’ and/or ‘failure to engage the patient.’

“The fault was not the patient’s; the fault was mine. What if I had engaged the patient in a conversation about weight reduction? What if I had discussed with the patient, the reasons why I don’t prescribe Ionamin, thyroid medicine, and diuretics for weight reduction? What if I had walked the patient through SETMA’s Adult Weight Management program? What if I had said, ‘While we are helping you lose weight, we can also help you control your diabetes?’

“Until last week, my memory of this patient’s care was that of excellence and of the sad rejection of that care by the patient. Today, I remember this patient’s care as my failure due to the hubris of ‘my thinking that I knew better.’ If my goal had been to help this patient and it was and is, then I should have met the patient’s needs and expectations in order to gain the opportunity to meet the patient’s real health needs. As it turns out, I have the opportunity to do neither.

“The recognition of having made a mistake

“Plutarch said, ‘To make no mistakes is not in the power of man; but from their errors and mistakes the wise and good learn wisdom for the future.’ My mistake can be forgiven if I learn from it. And, how will I evince that learning?

“I think I shall never see a patient without asking the question, ‘What is your goal?’ ‘What do you want to achieve in this visit and in the care you will receive from this clinic?’ That question is partially answered when the patient-encounter record documents the patient’s ‘chief complaint.’ But to make it more explicit, we are today adding a comment box to each disease management suite of templates and to each suite of templates. It will be labeled: ‘Patient Goal.’ It will be expressed in the patient’s words. While we want to use structured data fields, this may be one case where structured data fields obscure the issue. As we have more experience with shared-decision making, we will clarify this data field more precisely. But, we will never ignore a patient’s personal goal again. And, if the patient’s goal is something which is inappropriate, or which can’t or shouldn’t be done, we will address that directly and frankly, rather than just by ignoring it.

“Learning and Personal Mastery

“We all do still have a great deal to learn, but if we are alert and attentive, if we are willing to be honest with ourselves, we can and we will learn. We will do this as we continue to pursue what Peter Senge’s calls ‘personal mastery,’ which is ‘the discipline of continually clarifying and deepening our personal vision, of focusing our energies, of developing patience, and of seeing reality objectively which is the learning organization’s spiritual foundation.’ (Senge, The Fifth Discipline, pp. 7-8)

“People with a high level of personal mastery share several basic characteristics:

‘The have a special sense of purpose that lies behind their vision and goals. For such a person, a vision is a calling rather than simply a good idea.
‘They see current reality as an ally, not an enemy. They have learned how to perceive and work with forces of change rather than resist those forces.
‘They are deeply inquisitive, committed to continually seeing reality more and more accurately.
‘They feel connected to others and to life itself.
‘Yet, they sacrifice none of their uniqueness.
‘They feel as if they are part of a larger creative process, which they can influence but cannot unilaterally control.
‘Live in a continual learning mode.
‘They never ARRIVE!
“(They) are acutely aware of their ignorance, their incompetence, their growth areas.
‘And they are deeply self-confident!’ (IBID., (p. 142)

“I hope I get to meet this patient again. And, if I don’t, I shall see her/him in the face and eyes of every patient I see, as I focus upon their goals and desires in order to have the privilege and opportunity to meet their real health needs.”

Paternalism or Partnership

Perhaps nothing illustrates continuous learning and the willingness to have one’s opinions, positions and even convictions challenged than is the underlying structure and dynamic of healthcare delivery which when I did my formal training was a “paternalistic” didactic model between teacher and student and then between physician and patient. The change from paternalism to partnership which we found in the patient-centered medical home was dramatic and stressful, but it was necessary and critical.

Healthcare and Paternalism

In a September, 2013, article which can be reviewed at: Paternalism or Partnership: The Dynamic of the Patient-Centered Transformation, I said:

“These structural principles will only take SETMA so far in becoming a true ‘medical home’. The next step is a radical change in the dynamic of care, a dynamic which will address how medical colleagues relate to one another and how they relate to those they serve. As will be seen below, five months after SETMA defined the structural changes needed for being a medical home, we discovered that on October 1, 1999, we had defined the new dynamic. Under the old model of care, which we might refer to as a paternalistic healthcare system, patients were very often told what to do and it was expected that they would follow the healthcare providers’ instructions without modification. The definition of ‘paternalism’ helps understand the old model of care; it is: ‘A policy or practice of treating or governing people in a fatherly manner, especially by providing for their needs without giving them rights or responsibilities.’

“The dynamic of the medical home redefines the relationship of healthcare provider and patient, and changes how they relate! Rather than the patient encounter being didactic (to lecture or teach, as one with knowledge, instructions or informs those who do not) - where the healthcare provider tells the patient what to do, how to do it and when to do it - the patient/provider encounter becomes a dialogue (An exchange of ideas or opinions) - where the healthcare provider and the patient discuss a mutual concern and then together come to a mutual conclusion with a mutually agreed upon plan. This new relationship is somewhat like a partnership. In that context, the following is a note I wrote to my colleagues Friday, December 20, 2013. The note said:

“SETMA’s URAC Medical Home Survey is over.

“URAC gives two levels of results to an application for a survey. If all mandatory standard elements are met and an overall score of 85% is met for PCMH and 85% score for EHR is reached then the practice will receive PCMH Certification with EHR.

“That is SETMA’s result. We now have:

“NCQA Tier III PCMH (2010-2016)
“AAAHC PCMH and Ambulatory care (2010-2014)
“URAC PCMH with EMR (2014-2017)

“In February we will have a survey by Joint Commission. Congratulations to all. SETMA has done and is doing a great job. If we continue to learn and continue to improve, we will lead the way into the future of healthcare transformation.
“Of the 15% of practices in America who have one Medical Home accreditation, only one has more than one, and that is the only one which has three and which will soon have all four, i.e., SETMA,LLP. We work hard at being a Learning Organization which is made up of learners. We ARE extremely self confident, while at the same time feeling that we never ARRIVE, and while we are acutely aware of our ignorance, our incompetence, and the areas in which we need to grow.”

Dr. Chandra, I enjoyed my time with you last year at the Harvard Kennedy School. It is unnecessary for you to know me better, but hopefully this note will let you know that while I hold my beliefs deeply, I am as deeply committed to dialoguing with others from the position of openness, transparency and willingness to learn. We should welcome into our conversations those who are deeply committed to their world view and to the lessons learned from their life-experiences and study, as we invite and even challenge them to look at their views and as we allow them to challenge our views and opinions.

Larry

James (Larry) Holly, M.D.
C.E.O. SETMA
www.jameslhollymd.com

Adjunct Professor
Family & Community Medicine
University of Texas Health Science Center
San Antonio School of Medicine

Clinical Associate Professor
Department of Internal Medicine
School of Medicine
Texas A&M Health Science Center

The above is in response to

From: Amitabh Chandra
Sent: Saturday, December 21, 2013 3:32 PM
To: Ling, Horace; James L. Holly
Subject: RE: Harvard Shaping Healthcare Delivery Policy Program Updates

Hi Dr. Holly,

So good to hear from you! One point of clarification to your email where you say that I am “...not interested in talking to those who were knowledgeable or at least opinionated about the issues being discussed.” I don’t remember saying this, and I certainly don’t believe it. But what I do say is that I don’t talk to people whose mind is made up and whose views cannot be challenged. We have to be open to learning- as your writing reiterate again and again!

Hope this helps.
Merry Christmas and Happy Holidays to you and your family
-Amitabh.

Which was sent in response to the following note:

From: James L. Holly [mailto:jholly@jameslhollymd.com]
Sent: Thursday, November 07, 2013 9:28 AM
To: Ling, Horace
Subject: RE: Harvard Shaping Healthcare Delivery Policy Program Updates

Thank you for the contact. I had not thought about coming back to the conference because Dr. Amitabh Chadra made it clear to me that he was not interested in talking to those who were knowledgeable or at least opinionated about the issues being discussed. I assumed then that the conferences were for beginners. If that has changed I may arrange my schedule to return for another conference. I will be interested in your response. Thank you James (Larry) Holly, M.D.

About SETMA	In The News	Syllabus PC-MH Externship	Patient Information	Presentations
Governance Board	Your Life Your Health	Public Reporting	Accreditations/Awards	Diabetes Center of Excellence
EPM Tools	Transforming Your Practice Library	Medical Home	I-CARE Initiative	NextMD