Weiss Pediatric Care on target to become Sarasota County's first Pediatric Medical Home
SARASOTA—On their 40th wedding anniversary, Rob and Diane Weiss could’ve been celebrating retirement from a bucket list of travel spots.
Instead, the Weiss family marked the turning point by opening Weiss Pediatric Care in Sarasota, one of 14 participants in a rigorous statewide demonstration project that has the practice squarely on the path to become Sarasota County’s first Pediatric Patient-Centered Medical Home (PCMH).
“When you get to this stage in your professional career, people start thinking about retirement or at least slowing down,” said pediatrician Rob Weiss, MD, FAAP, who celebrated a birthday by sharing his story. “We had a choice to do that. Dianne likes to say, ‘We could be going to Paris; instead, we opened an office.’ We felt if we were going to do this, now is the time in our lives professionally … while we’re still young enough and passionate enough to give it the time to make it successful.”
Teamwork bodes well for the Weisses, parents of three children ages 27 to 35. In the practice, Diane Weiss, MS, serves as practice manager, parenting and child development specialist, and lead team member for the Medical Home Demonstration Project.
“We wanted a model that looked at the family and child as an entire package rather than sporadic visits,” said Rob Weiss. “We became aware of the Patient-Centered Medical Home, which dovetailed nicely with our goal.”
This is a whole new world, said Rob Weiss, who marks 36 years of practicing medicine this month.
“I cut my teeth and have grown up on the model of coordinated practice between multiple doctors, larger groups and coverage groups,” he said. “There’s always been a dance making a decision on individual changes when approaching patient care in a collaborative effort between multiple physicians. Often, the roadblocks to making significant choices are enormous. You’ll find that many times, it’s daunting to make a change among multiple providers. What’s exciting about this concept is that it’s a limited group with a coordinated effort to produce a product that keeps with this model.”
The Florida Pediatric Medical Home Demonstration Project, initially launched in 2010 with 20 pediatric practices, is designed to provide physicians and their staff with strategies, tools, and resources necessary to strengthen medical homes’ capacity to provide high quality, family-centered care for all children and youth, including those with special healthcare needs. Weiss Pediatric Care is among select practices statewide to participate in a phase slated for completion this year. The 14 pediatric practices are assessing the effectiveness of the systems of care they provide and implementing tests of change with the aid of tools, strategies and measures to improve these systems.
“It takes time to gather important data,” said Rob Weiss. “Our practice isn’t designed for families who want to rush in and out.”
The greatest challenge internally has been accomplishing required tasks without making the workload unbearable.
“It means longer days for Dianne and me, but it’s exciting … that’s surprised me,” he said.
For example, the daily huddles to discuss each patient’s condition and treatment plan have become a vital early-morning routine.
“It starts the day on a different kind of note,” he emphasized. “Before we even see the patients, we ask them to complete a questionnaire addressing developmental and behavioral issues, and general concerns parents may have before the doctor even comes into the room. This checklist helps us maximize the communication opportunity with the family. When they leave, we review the information on the discharge summaries with the parents.”
The practice has established a computerized tracking system to follow patients who have been referred for specialty care, measure outcomes and determine priority areas for interventions.
“We know what roles everyone will play, and we put this all together in a care plan package so that it’s a more coordinated effort,” he said.
Weiss Pediatric Care also began offering Saturday office hours to make care more accessible for established patients; and, rather than delegate after-hours calls to a back-up group, the team fields all calls and questions that can’t wait till the next business day.
“With ours, I can access information at home on my cloud to better help my patients after hours,” said Weiss. “It sounds very daunting time-wise, but people have been very respectful … once you learn the dance steps, it becomes quite doable.”
As Weiss Pediatric Care celebrates its one-year anniversary, Diane Weiss raved about the improvements made across the board.
“It’s been one of the most challenging endeavors of our professional lives, but what a difference it makes,” she said. “It truly transforms the way you provide care by better anticipating and addressing the needs of families, particularly those who have children with special needs.”
The ‘Unseen’ Medical Home
A medical home is not a building, house, hospital, or home care service, but rather a model of primary care delivery developed by the American Academy of Pediatrics (AAP). According to the AAP, characteristics that define a medical home include care that’s accessible, continuous, comprehensive, family-centered, coordinated, compassionate and culturally effective. The medical home is community-based, interdisciplinary, and uses a team approach to provide preventative, acute and chronic care.
The medical home concept promotes seven key principles:
1. Personalized medicine.
2. Physician-directed medical care.
3. Whole person orientation.
4. Coordinated care.
5. Evidence-based medicine (EBM), benchmarked and measured.
6. Enhanced access to care.
7. Added value.
SOURCE: American Academy of Pediatrics.
A Labyrinth Plan
The American Academy of Pediatrics (AAP) spurred development of the Florida Child Health Insurance Program Reauthorization Act (CHIPRA) quality demonstration grant, with the assistance of the Agency for Health Care Administration and the Florida Department of Health. CHIPRA funding is being used to strengthen medical homes' capacity to provide high quality, family-centered care through the Florida Children's Medical Services Network for CYSHCN. The project focuses on quality improvement in practices and is being administered and implemented via the AAP Quality Improvement Innovation Network and the AAP Chapter Quality Network.
The University of Florida Institute for Child Health Policy is conducting an overall evaluation for the initiative; staff in the AAP Division of Children with Special Needs is also involved in all areas of the comprehensive approach.
Ramping Up Pediatric Medical Homes
For a state well-known for managing challenges inherent of caring for a soaring senior population, Florida has perhaps surprisingly become a front-runner concerning promising initiatives that focus on the smallest population segment: children.
The Florida Pediatric Medical Home Demonstration Project will soon wrap up its third full year of implementation.
The first round of 20 participant teams began their work in August 2011; it was completed in April 2012. Of this group, 16 practice teams elected to continue with the second phase of the project, which took place from May to December 2012. The project was replicated such that a second round of 14 practice teams joined and began their work in August 2013. Of this Round 2 group, a dozen practice teams will continue onto a second phase of the project, which will end in December.
In one of few such pacts, Florida and Illinois share an $11.3 million, five-year grant that will end in 2015. The two states are testing collection and reporting of recommended and selected supplemental measures of children’s health quality, using existing data sources and improved data sharing. The two states are also working to ensure that ongoing statewide health information exchange and health information technology efforts support the achievement of child health quality objectives and to enhance the development of provider-based systems of care that incorporate practice redesign and strong referral and coordination networks, particularly for children with special needs. Florida and Illinois are also supporting collaborative quality improvement projects to improve birth outcomes across the two states.
For the CHIPRA Cycle II grants that Florida was among 23 states to receive to fund aggressive initiatives that reach a large quantity of eligible children, priority areas include using technology to facilitate enrollment and renewal, and engaging schools in outreach, enrollment and renewal activities.
For example, the University of South Florida (USF) in Tampa received $1 million in CHIPRA funds to engage school districts in outreach and enrollment activities. Rural school districts receive special attention, and also school districts with large populations of limited English proficient (LEP) students. A multi-media teen marketing campaign and curriculum target uninsured adolescents in high schools. USF is also working with the Florida Association of Children’s Hospitals to increase the number of school professionals trained to identify and assist eligible families with applications.
Round 1 Practices (past):
All Children’s General Pediatrics, St. Petersburg
Altamonte Pediatric Associates, Altamonte Springs
Atlantic Coast Pediatrics, Merritt Island
Brevard Health Alliance Monroe Center, Cocoa
Children’s Health of Ocala, Ocala
Gentle Medicine Associates, Boynton Beach
Jacksonville Beach Pediatric Care Center, South Jacksonville Beach
Longleaf Pediatrics PA, Orange City
Martin Memorial Pediatrics, Stuart
Mirtha Cuevas MD Inc, Orlando
Orlando Health Pediatric Faculty Practice, Orlando
Pediatric Associates–Miami Beach, Miami Beach
Pediatric Clinic, Memorial Primary Care Center, Hollywood
Pediatric Partners, Palm Beach Gardens
Rozalyn Hester Paschal MD, PA, Miami
St. Vincent’s Family Medicine Center, Jacksonville
Tallahassee Pediatrics, Tallahassee
The Chronic Complex Clinic at St. Joseph’s Children’s Hospital, Tampa
University Pediatrics, University Park
USF Pediatrics South Tampa Center for Advanced Healthcare, Tampa
Round 2 Practices (present):
A to Z Pediatrics, New Port Richey
Angel Kids Pediatrics, Jacksonville
Bloomingdale Pediatric Associates PA, Valrico
Caladium Pediatrics, North Lake Placid
Halifax Keech Health Center, Daytona Beach
Lee Physician Group Pediatrics, Lehigh Acres
Martin Memorial Pediatrics, Port St. Lucie
Miami Children's Hospital Pediatric Care Center, Miami
Pediatric & Adolescent Medicine of Seminole, Longwood
Premier Pediatrics, Ocala
UF Health Pediatrics—San Jose, Jacksonville
Weiss Pediatric Care, Sarasota
The Wolff Center for Child & Adolescent Health, Pensacola
Wolfson Center for the Medically Complex Child, Jacksonville
SOURCE: Agency for Health Care Administration.