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	James L. Holly, M.D.

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Your Life Your Health - What Should SETMA Expect in 2014?

James L. Holly,M.D.

January 23, 2014

Your Life Your Health - The Examiner

In August of 2014, SETMA will begin its 20th year. Only five years later, August, 2019, SETMA will begin its 25th year. By the celebration of our 25th anniversary in August 2020, the changes in healthcare and in SETMA will be phenomenal.

The Reach of SETMA’s Healthcare Model of Care

January 6, 2014, SETMA opened its Lumberton office, our sixth in the Golden Triangle. In conjunction with and co-located with the Altus Emergency Care Center, this facility will bring continuous health care to Hardin County and surrounding areas. Because SETMA’s system is integrated across all of its locations, those who choose SETMA for their ambulatory care will be interconnected via:

SETMA’s digital telephone system, which is capable of supporting 99,999 internal telephone extensions and/or external numbers..
SETMA’s Intranet, our internal communication capability, allows secure communication between all SETMA locations.
SETMA’s internet where SETMA displays all of SETMA’s work, achievements and tools helping achieve the SETMA community.
SETMA’s electronic health records (EHR) which fulfills all requirements of HIPAA security and health information protection, and which creates a data-driven, continuity-of-care regardless of where a patient is seen.
SETMA’s connection with all inpatient facilities in Southeast Texas via Citrix technology expanding our continuity-of-care to all area hospitals.
SETMA’s Health Information Exchange which expands a data-driven, continuity-of-care with all SETMA’s partners, even when they are not a formal part of SETMA.
SETMA’s patient-centered medical home and accountable care organization functions.
SETMA’s national-award-winning innovations, which introduce the latest national and evidence-based standards of care, simultaneously to all SETMA care.
SETMA’s tracking, auditing, analyzing and reporting of quality performance across all locations, allowing quality of care improvement to be simultaneously supported across all locations.

Also, in the first quarter of this year, SETMA will open its 7th location. The details will be finalized and an announcement will be made in January. This is the first step SETMA is taking to expand beyond the Golden Triangle. It will be SETMA’s first demonstration of the value and power of electronic-patient-management, which can easily be translated from one geographic location to another. This is a long way from SETMA’s founding in 1995, when communications from one pod to another, in the same building, was difficult and when quality improvement and tracking of provider performance was practically impossible.

In 2014, SETMA will also be adding new providers and specialists to our staff. Three new partners have been elected by SETMA. Drs. Damien Luviano, Phuc Le and Ronald Palang will begin their new responsibilities at SETMA this month.

Patient-Centered Medical Home (PC-MH)

February 16, 2009, SETMA colleagues attended a meeting on PC-MH. After that meeting, SETMA was asked, “Are you serious about medical home, or is this just a passing interest?” SETMA answered, “Only time will tell.” At Your Life Your Health - Medical Home, there are over 108 articles on medical home, written by SETMA, which document SETMA’s journey to becoming a medical home. At the present, only 15% of primary-care practices are recognized or accredited as medical homes. Only one practice has multiple accreditations.

There are four organizations which recognize or accredit practices as medical homes. After achieving its first two accreditations in 2010, SETMA set a goal of achieving all four organizations’ medical Home endorsements. In the intervening years, SETMA has renewed those first two endorsements for a second three years. In Your Life Your Health for January 9, 2014, the following history was given for SETMA’s medical home achievements:

The National Committee for Quality Assurance (NCQA -- http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx) and has received the highest designation, Tier III, for 2010-2013 and 2013-2016.
The Accreditation Association of Ambulatory Health Care ((AAAHC -- http://www.aaahc.org/accreditation/primary-care-medical-home/) and has received the highest designation by AAAHC for 2010-2011, 2011-2014.
URAC (Known only as URAC -- https://www.urac.org/accreditation-and-measurement/accreditation-programs/all-programs/patient-centered-medical-home-achievement/) and has received the highest designation as PC-MH Certification with EHR. .

This leaves only the Joint Commission accreditation to be achieved. Their four-day site visit will take place March 3-5, 2014. The Joint Commission’s 18-chapter, over 700-page Standards and Requirements for Medical Home Accreditation 2013, has been reviewed by SETMA to make sure that we meet all of the requirements. Of course, that will only be known after our survey has been done, but at this time, we expect to be successful. With this final step, SETMA will hold all four organizations’ approval simultaneously and SETMA will be the only practice in the nation who will hold all four. Also in 2014, SETMA will renew our AAAHC Ambulatory Care and Medical Home accreditation.

Meaningful Use (MU) of Electronic Health Records (EHR) - Interoperability and Quality Reporting

Having met the standards in 2012-2013 of the Health and Human Services’ (HHS) department of Health Information Technology’s (HIT) Office of National Coordinator (ONC) for Meaningful Use Stage I (MU1), in 2014, SETMA will make the changes in our EHR to meet Meaningful Use II (MU2) standards, and to be prepared in 2017 to meet MU3 standards most of which will related to PC-MH functions.

The complexities of meeting these standards is shown by the fact that of 500 EHR vendors currently in operation only 4 have achieved certification for MU2 2014. Providentially, one of those is the EHR product which SETMA purchased March 30, 1998. On the morning of December 5, 2013, SETMA sent an appeal to ONC and to the Centers for Medicaid and Medicare Services (CMS) requesting a two year delay in MU2. That letter can be read at http://jameslhollymd.com/Letters/pdfs/an-appeal-to-cms-and-onc-for-a-temporary-exemption-to-meaningful-use-2.pdf. Coincidently, in the afternoon of December 5, 2013, ONC and CMS announced a one-year delay in Meaningful Use III (MU3), which gives SETMA time to meet MU2.

This process will occupy a great deal of our time in 2014 and may cost as much as $500,000 but within 2014, SETMA will fully achieve MU2, the only part of which is a problem for SETMA is interoperability. As to quality reporting, on January 3rd, SETMA will post, by provider name, performance on over 300 quality metrics. This completes five years of such reporting, which will be continued for 2014 and for future years. Those results can be reviewed at the following link: http://jameslhollymd.com/public-reporting/public-reports-by-type

There are many other projects and goals SETMA has undertaken for 2014, but these are important ones. We are anticipating a great year.

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