Wired Family Medicine
By Ray Smith
From Issue 29: Winter 2016
In June, 2015, Gardiner resident Frances C. Mayle III M.D. and Dawn Dooley FNP, who had been practicing primary care medicine as Modena Family Practice since 1984, joined Health Quest Medical Practice. Health Quest is the largest family of nonprofit healthcare providers in the Hudson Valley, encompasing three hospitals and small practices in over 20 locations. Dr. Mayle and his staff continue to practice at the same location, off Route 32 in Modena.
Dr. Mayle explained why, in this day and age, going from small to big is the right answer, not only for him but for our community as well. “All professions and jobs in our society have changed dramatically,” Mayle says. A computer system is necessary to manage patients through hospitals to out-patient facilities to nursing homes and back to the practice, and none work well at this stage. Plus, for a sole practitioner to construct such a system and hire people for case management is too costly. “Being part of a group and pooling and centralizing overhead results in major cost savings.”
Dr. Mayle added that an alternative would be to operate a “concierge” type practice, taking only a small number of patients, who would pay to be part of the practice and then pay the doctor when he sees them. “But that would cut out a large portion of patients we’ve seen for thirty years. We didn’t want to do that.”
An immediate benefit to patients has been the Patient Portal via the Internet: patients can view the doctor’s summary of their visits; lab test results; request an appointment or prescription refill online; share medical information with family members or others; and send an email message to the practice. This last eliminates voicemails and telephone tag and, more importantly, the message to the practice goes to Terry Wager, Supervisor, Modena Primary Care, and not to some distant back office. You also get a quick response.
HealtHQuest has taken over the billing, insurance contracts and other paper work. Admittedly, over the short term, learning and integrating the new systems and using EMR (Electronic Medical Records) have been “arduous tasks to learn.” When I asked Dr. Mayle if he was a touch typist, he smiled over his glasses and said, “Yes. One finger at a time.” Even so, it’s a huge improvement over the usual physician’s illegible scrawl. The old paper charts are retained, recent ones in the office but, if a patient has not been seen in three or four years, they’re stored elsewhere in a secure location. Eventually, all the paper charts will be taken out and stored in a secure location.
Besides the HealtHQuest signs, the first change to strike patients is the new flooring. Carpet replacement and a redo of the outside of the building had already been planned but were put on hold in order to allow HealtHQuest to have input.
In the consolidation, HealtHQuest was sensitive to patient concerns, especially the ability to reach staff members they had been dealing with for years. For example, the telephone tree (aka pushing buttons) you now get when you call the practice was not put in place until the practice had been part of HealtHQuest for over four months, and even now, if you push 0 or 6, you will get a familiar, friendly person in the Modena office.
The idea, ultimately, is to have four providers in the office and Dr. Mayle hopes to expand that to other sub-specialties as well. Cardiology is already present in the person of Dr. Daniel O’Dea who is at the office Thursday afternoons. Dr. Mayle finds that getting patients used to a different organization—and convincing them that he isn’t immediately retiring—has been far harder.
In fact, the HealtHQuest connection facilitates the continuation of the practice whenever he does retire. “They’re going to keep it running because it’s good for them and good for the community. If I retired before I did this, the office would close and there would be no family practice here anymore. Selling a practice as an ongoing business hasn’t happened in a decade or more. The value of the practice ends up being only what you can sell the equipment for. Sale of the patient list doesn’t happen anymore; money for good will doesn’t happen anymore.”
Mayle plans to be there for at least five years and says, “I hope that with this move the physicians practicing here twenty years from now will be taking care of the community as I’ve done for the last thirty years.” He adds that the practice has always grown, without advertising, and HealtHQuest has the ability to make sure it continues to grow.