Health Innovations in Our Community - Trillium Family Medicine
February 7, 2013
The Western Carolina Medical Society recently interviewed WCMS member Dr. S. Mark McNeill from Trillium Family Medicine as the first in a series highlighting health innovations practices in Western NC.
The Perfect Practice
Early in the morning before the first patient arrives and after the patient portal and emails are checked, Trillium Family Medicine starts with “the huddle.” Sole practitioner Dr. Mark McNeill, practice manager Jill LaBelle, and medical assistant Tammy Jessup gather to plan and prioritize for the day. Trillium is one of a number of independent small practices in WNC that are successfully challenging conventional thinking about the capacity of small practices to be financially stable while growing and delivering quality care in a cost-efficient manner.
Why Trillium? Why Now?
Dr. McNeill lives by the credo “Think out of the box and embrace change.” Dr. McNeill’s journey began when he worked in New Zealand in their healthcare system, where average overhead is significantly lower than in the United States. In the family medicine practices where Dr. McNeill worked thereafter, he became an “electronic czar,” enjoying the EHR experience, becoming known as the “Agent of Change.” These experiences evolved into the idea and model for his “perfect practice.” His goal was to establish a low-overhead model right here in WNC, using technology as his key tool.
McNeill starts by saying, “The days of running a practice as in the past are long gone. I sought to create a low overhead office using the technology available. The key is to train patients to use a web-based patient portal as their primary form of communication instead of the telephone. The patient portal is the pivotal component. It is a customized/modified version of E-Clinical Works – a product that suited my needs.”
Trillium Family Medicine is committed to providing compassionate, patient-centered, high quality care that is available to patients from children through adulthood. Through efficient use of office staff and information technology, they believe that they are able to offer exceptionally accessible and personal care in a comfortable atmosphere.
A technology-based practice means patient-centered workflow with less staff and with greater efficiency. Dr. McNeill finds that the accessibility created by the use of the patient portal significantly reduces patient anxiety and improves the doctor-patient relationship. Pre-appointment interviews are done via the web patient portal. The staff reviews patient information ahead of time, which saves documentation time; since the on line documents are tied to the EHR, the practice achieves great time savings and efficiency. Because most of the patient’s health data is collected via the portal, during the actual patient appointment Dr. McNeill spends most of his time talking directly with the patient, making eye contact, and strengthening the physician-patient relationship, instead of entering data in the exam room.
The Patient Portal- Access is the Answer
Patients may login 24/7 to schedule their own appointment at their convenience. “Patients are trained on the portal at their first visit and encouraged to use it. 70% of our patients use the patient portal for scheduling appointments and information uploads. This number continues to grow. This approach appeals to the younger generations as well as older patients so inclined to use technology,” says Dr. McNeill. Dr. McNeill and his staff at Trillium Family Medicine highly value accessibility. McNeill continues, “We have an ‘open access’ schedule which is different than most practices in the area. This means we do not fill up the schedule weeks ahead of time like most practices. We make sure that there are same day and next day appointments available every day. Same day sick appointments will not be turned away. In addition to this you will always see your physician rather than being passed around to whichever doctor is available when you feel ill.”
“Only needing to see 16 patients on average a day allows us greater flexibility in the schedule,” adds McNeill. “We encourage our patients to make their follow up appointments only a few days in advance to avoid having my scheduled booked out days or weeks. This eliminates no-shows considerably and the need for re-scheduling. With availability being one of our core values having a flexible open access schedule is crucial to what we are trying to create.”
Use of the patient portal also allows patients unprecedented access 24/7 to their primary care physician. Dr. McNeill uses secured emails on the patient portal to communicate with his patients. He says that they love it because they get to hear from him directly rather than being passed through nurses and other personnel. He responds to all emails himself and finds it is not hard or time-consuming. The emails are checked early in the morning then every 2 hours throughout the day for a timely response.
McNeill adds, “By using the latest technology in the form of a secure patient portal, you can get what you need quickly by securely messaging me, including prescription refill requests, lab requests and routine questions. During our business hours these messages are dealt with the same day and quickly. The portal also allows our patients to schedule their own appointments. This means no waiting for the office to open and waiting on hold.”
What does “growth” mean to Dr. McNeill? Growth occurs when 1) the Trillium mission is fulfilled for his patients 2) Trillium maintains its high-value level of service as the practice expands 3) in the future others can follow such models successfully—it will be a victory for independent practices to be able to not only survive but thrive in an era of healthcare reform.
How is Trillium positioning itself to handle or manage various aspects of healthcare reform? Dr. McNeill answers by saying, “We know there will be a flood of people looking for doctors. Being able to do electronic visits through the portal will be crucial to accommodate the influx. Common issues - such as urinary tract infections, colds, and high blood pressure follow-up - can be ideal for electronic visits. Also, the type of care we give is the type of high value care that will be incentivized more in the future by both private and public payers.”
Trillium is not a boutique practice; the practice takes Medicare and Medicaid patients. According to practice manager Jill Labelle, “All insurances that Dr. McNeill took at his previous practices he is taking now. Dr. McNeill provides care to the uninsured and participates in all of the insurances—both public and private—offered in the region. His payer mix is estimated as 35% Medicare/Medicaid, 5% uninsured and the rest private insurance.”
Who were helpful influencers in creating Trillium?
McNeill credits some other national and local innovators with his success. “Dr. Steven Crane was a huge influence. Also, Dr. John Bachman at Mayo Clinic, Dr. Allen Wenner in Columbia, SC, former MAHEC colleague Dr. Betsey Sorenson, and East Asheville Family Health were extremely helpful and had good ideas.”
We asked Dr. McNeill what advice he would give to other independent practices struggling to find ways not only to serve but thrive as healthcare reform takes hold.
Collaboration. ”The ideas are there. Good literature on the subject is available.” You do not need to re-invent the wheel.”
Use models of innovation. “I feel good knowing there are exciting options available… seek them out.”
Keep lean with low overhead. “This allows you more flexibility on how to run your office."
Embrace technology. ”This is the key to maximizing efficiency, so build your processes around it.
Think out of the box and embrace change.
Trillium Family Medicine, PLLC
S. Mark McNeill, MD
675 Biltmore Ave, Suite F