TMF Health Quality Institute congratulates Saline Med-Peds Group in Benton, Arkansas, for receiving a 2016 - 2017 Physician Practice Quality Improvement Award for its commitment to improving patient care. Saline Med-Peds Group is recognized for demonstrating excellence in two Physician Quality Reporting System (PQRS) measures: Tobacco Preventive Care and Screening (99.82 percent) and Diabetes: Medical Attention for Diabetes (96.44 percent).
Saline Med-Peds Group is a small office led by Mark Martindale, MD, who is board certified in internal medicine and pediatrics. His father, Joe Martindale, MD, still comes to work every day, and they have a physician’s assistant help out in the afternoons. Cindy Martindale, RPh is the pharmacist and office manager. She says the practice is also staffed with two registered nurses and two licensed practical nurses. The practice also has an employee who schedules patient appointments.
Smoking and Tobacco Cessation Best Practices
For years Saline Med-Peds Group has been able to lessen the number of smokers in the practice, which sees 520 Medicare patients, by incorporating smoking cessation into its workflow, adding signage in all patient rooms and offering weekly smoking cessation classes.
“There’s a prompt in the computer to remind staff to ask patients [if they smoke], so everyone is asked about it,” Cindy said. “If they’re a smoker, they are counseled on that and offered options. Arkansas has a Stamp Out Smoking program, so we can sign them up for that. We ask them questions, fax the form in, and the Arkansas Department of Health notifies the patient that they are enrolled in the program. The program provides patients with free nicotine patches and resources, and program specialists will call or text the patients with guidance to help them to quit.”
Within the last year, Dr. Joe Martindale has offered a weekly smoking cessation class. ”It’s not that easy to get them to come, but he’s very good with that,” Cindy said. “He’s 86 years old and can be very convincing.”
Diabetes Education Best Practices
Saline Med-Peds Group has had similar success with its approach to diabetes care.
“We have a free diabetes education class every other month, so for people who are newly diagnosed or struggling, we have lunch and learn sessions,” said Cindy. “Sometimes the doctor will do a class, but most of the time we have a diabetes educator talk to patients about nutrition. Patients do real well with that,” Cindy said.
The practice sees patients with diabetes at least two times a year and most of them four times per year. Overall, she says the classes have been very positive.
“It’s harder to get people to go to smoking classes, but the diabetes class fills up every time,” Cindy said. “The best thing is for the physician to ask them to go to class -- that carries more weight than anything else.”
Saline Med-Peds Group also worked on the Arkansas Clinical Transformation (ACT) Collaborative, a health care system interventions program sponsored by the Arkansas Department of Health. The practice learned the Plan-Do-Study-Act model through ACT.
“We focused on diabetes, studied it for a couple years, looked at the numbers and fixed where we weren’t doing well,” said Cindy. “Our nurses are very well educated in what needs to be done. Diabetes is something we follow closely on. When patients leave, they have their next appointment scheduled in three months. We keep checking on them.”
Cindy says what really helps their patients with diabetes improve their health outcomes is working with a dietician who teaches them how to live a healthy life and manage their diabetes.
“Educating them helps them eat better,” said Cindy. “That’s what we found had helped the most, so that’s what we focus on. They can attend as many classes as they want, they can ask questions; it’s kind of a support group. They see they’re not alone and get a lot of good tips. Most people can find something to change.”
Improving Clinical Outcomes
The practice is also part of the Center for Medicare & Medicaid Innovation’s Comprehensive Primary Care Plus (CPC+) model.
“We’re one of those clinics where we’re always trying to improve,” Cindy said. “We took our nurses and made them all into care managers, trained by our physicians. We risk-stratified patients, so each one has a score. The sickest have their own care manager. Each nurse has a list of 20-25 patients that they’re to check on and see each time, and they personally follow through with all their care, instead of multiple employees. That’s what we started through CPC and that has helped a lot.” Cindy said they added additional nurses, who act as scribes during the doctor’s visit, draw blood, and submit paperwork to specialty practices. This way, high-risk patients have one personal nurse.
In the nurses’ station, Saline Med-Peds Group installed a large whiteboard where the nurses list all of the measures that they’re following through the year to track them. One nurse was in charge of coordinating care and ensuring the practice met the goal for smoking cessation and diabetes management, while each nurse had one or two measures that they were in charge of tracking. “They worked hard on their own to improve those measures. They took pride in that,” said Cindy said.
About the Physician Practice Quality Improvement Award Program
The Physician Practice Quality Improvement Award program is sponsored by TMF in partnership with the Texas Medical Association, Texas Osteopathic Medical Association, Arkansas Academy of Family Physicians, Arkansas Osteopathic Medical Association, Oklahoma State Medical Association, Oklahoma Osteopathic Association and the Puerto Rico Medical Association. Any practice in the state of Texas, Arkansas, Missouri, Oklahoma and the territory of Puerto Rico with one or more licensed physicians providing care for Medicare fee-for-service patients is eligible to participate. For more information, go to https://award.tmf.org/Award-Programs/Physicians.