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Oncologist Blazes Trail Toward Bundling

Jacqueline Fellows, for HealthLeaders Media, February 6, 2014

"The heart of what we did, and the heart of this model, is really taking a critical look at the physician work environment and overcoming some of the barriers that we face as physicians on our way to becoming more accountable for quality and consistency of care and cost."

The work that led to gaining PCMH certification began in 2003 after Sprandio and others in the practice took to heart a 48-page white paper by Alice Gosfield and Jim Reinertsen MD, titled, Doing Well by Doing Good. It was a critical look at what Sprandio calls physician "time stealers" that prevented delivering consistent care.

"Variation is so common in healthcare delivery," he says, citing communication and documentation burdens as part of the reason for disparities among physicians, as well as systems that lack coordination, measurement, and outcome targets. "Anybody who says, 'There's five doctors or there's 20 doctors and we all do things pretty much the same,' they're delusional."

Instituting Standards
Getting physicians to start acting in a coordinated fashion may seem counterintuitive to the "art" of practicing medicine. But Sprandio is a strong believer in giving patients, especially cancer patients who are very sick and scared, a level of care they can trust.

"That desire, to get more consistent care, had a tremendous, tremendous impact on our processes of care and our workflow," says Sprandio.

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