The Physicians Foundation has awarded a number of grants to the Vermont Medical Society Education and Research Foundation to support physician leadership programs across the state of Vermont. Cyrus Jordan, MD, Medical Director of the Vermont Medical Society Education and Research Foundation, discusses the leadership initiatives and how they are helping practicing physicians improve healthcare in the state.

Q: Please tell us about the grants and how they were utilized.

A: Grants from the Physicians Foundation are helping Vermont physicians develop the skills they need to become strong, quality physician leaders that can navigate Vermont’s health policy arena with ease. Grant funds are being used to augment five existing physician leadership initiatives, all targeting policy changes needed to support continual improvement in patient care and maintain an attractive medical practice ecology in Vermont. The five leadership initiatives and their change targets are:

2. The VT Chapter of the American College of Surgeons proposal for a state-wide surgical resource allocation plan

4. The Vermont Region Hospitalist Community’s pursuit of high value care for Vermonters through a regional collaborative optimizing lab testing of inpatients

5. The VT Chapter of the American Academy of Pediatrics’ struggle to have the state direct adequate health reform resources towards child and family health care

Q: Why are these physician leadership projects important in today’s healthcare environment?

A: The Vermont legislature and current governor embarked on an ambitious plan to reform how health care is delivered and financed in 2013. To date, a few changes in the regulatory arena have been implemented, but significant proposals about delivery system redesign, new payment models and new financing of the system will be presented in the next two legislative sessions culminating in the spring of 2017.

Primarily supported through two previous Physician Foundation Leadership grants, Vermont physicians have had significant and unexpected influence on reform policy decisions. The principal vehicle for physician influence has been the two Foundation-supported physician leadership communities, the Vermont Region Hospitalist Community and the Core Community Practices Group. Both of these physician groups composed influential whitepapers that made recommendations for how the state’s delivery system should be designed to keep Vermont an attractive place to practice medicine and ensure that the overarching goal of health care reform is to improve things that matter to patients.

The current Physicians Foundation leadership grant is helping Vermont physicians consolidate and expand their policy influence.

Q: How have the grants helped to improve healthcare in the community?

Optimizing Laboratory Testing Collaborative is the most mature of the five physician leadership initiatives funded by the Physicians Foundation. This grant allowed for a rigorous, transparent and meaningful quality improvement effort affecting more than 90% of regional inpatient beds. It entailed changing clinician lab ordering behavior to ensure patients get only appropriate tests with minimal harm and inconvenience.

The nine participating hospitals upload billing and laboratory data to a secure data enclave at the University of Chicago. Monthly reports are sent to each hospital team, assessing the effect of their improvement tests and allowing comparisons to hospitals in the region. The effort has decreased unnecessary needle sticks, wasted blood and hospital acquired anemia and sleep disturbances.

According to Virginia L. Hood MB.BS, MPH, MACP, Professor of Medicine, University of Vermont, President American College of Physicians, 2011-2012 and ACP Board of Regents 2005-2012,

 “The VMSERF’s 2012 white paper on Safe and Effective Treatment of Chronic Pain in Vermont engaged more than 30 physician leaders with expertise in pain treatment, addiction treatment, palliative care, orthopedics, maternal fetal medicine, and emergency medicine.  Their recommendations formed the basis of the white paper and have been influential.  The recommendations have led to state government efforts to create a single set of recommendations for treating pain, and to physician leaders in several communities developing, sharing, evaluating and testing opioid treatment tools and procedures for prescribing opioids and for treating addiction in medical offices.”– Madeleine Mongan, Deputy Executive Vice President and Vice President for Policy, Vermont Medical Society

“The program has not only highlighted that physicians need to be involved as we seek to address healthcare reform in Vermont but also provides an avenue and method for that involvement in a tangible focused form.  Involved physicians re-engage as thought leaders in their areas and that spills over into other projects and energizes providers who were at the brink of burnout” – Joshua Plavin, MD, MPH Senior Medical Director Blue Cross Blue Shield of Vermont

Q: Since the completion of these grants, are there areas that need to be broadened / refined in order to meet the demands of the medical practice environment today?

A: There are always additional areas to explore when it comes to improving healthcare practices.

One area to explore further is additional improvements related to how hospitals work together to improve patient care. This includes issues such as bed availability, payment methods, transportation issues, safety and quality.

There is also more to study in terms of redesigning outpatient practices to extend beyond clinic walls, including how to utilize extenders and community partners in innovative ways in the areas of chronic care management and primary prevention.