Doctors Take to Practice Coaching

In implementing the Patient Protection and Affordable Care Act, there's at least one provision that Congress possibly felt it couldn't afford—or simply didn't care enough about—to fully fund. The healthcare reform law, which was upheld by the Supreme Court today, called for the establishment of coaching programs for physicians. Yet without much federal money, this program has flourished anyway at state and grassroots levels.

Several groups have initiated their own coaching programs through a variety of different funding sources. A report issued by the Commonwealth Fund  last month suggests that coaching helps physicians improve team-building, handle patients' chronic conditions, and enhance patients' access to care. Coaching also improves communication among staff, increases efficiencies, and saves costs. But the report also says there appears to be wide variation in the quality of such programs, and a need for standardization of training.

Generally, physician coaching programs are becoming more needed, as well as more popular, says Terry McGeeney, MD, MBA, a primary care physician who is president and CEO of TransforMED, a nonprofit firm created by the American Academy of Family Physicians (AAFP) to provide coaching services. The TransforMED program is headquartered in Leawood, Kan.

AAFP launched TransforMED in 2005 to advance practice improvement initiatives, such as those in medical homes, McGeeney says. Since then, TransforMED has worked with more than 500 primary care practices, impacting more than 11,000 providers and clinicians.

"Problems and challenges of primary care practices are pretty consistent across the board: access to care, communication, and local leadership," McGeeney says.

Physician practice coaching—often geared to hospitals that employ many physician groups—is particularly important in smaller communities that lack the "robust quality improvement infrastructures" found in larger hospitals and big medical groups, the Commonwealth Fund study states. "The majority of primary care practices simply lack the expertise, will, or resources to improve care for their patients, and they need help," the report says.

Surprisingly, practice coaching has its roots in agricultural models of the early 20th century, where agricultural experts and farmers would develop collaborative relationships and share best practices. "Just as small farmers were most in need of the kind of support, it is these smaller physician practices that are most in need of help," the Commonwealth study states.

Whether practices are big or small, it is becoming more difficult for primary care physicians to spend time on improving care, according to McGeeney, and the situation is likely to worsen with impending physician shortages.

Practice coaching programs are being developed across the country on state and regional levels. Although the PPACA created a nationwide Primary Care Extension Program—perhaps named after the agricultural extension concept that predates it—Congress did not appropriate funds for this program. It is estimated to cost $120 million annually.

The Commonwealth Fund study cites reports showing that the effectiveness of practice coaching can be related to care for patients and improvements in physician practices adhering to evidence-based guidelines.

TransforMED initiates mostly peer-to-peer coaching. "We go into a practice and let [physicians] tell their stories and create a peer support group," McGeeney says. "It really accelerates the transformation of a practice." The coaches come from a wide range of specialties, and include physicians, nurses, and other health professionals or counselors with advanced degrees.

Most physician groups and hospitals prefer to have coaches with real-world experience, McGeeney says. Each coach "has to be immediately credible when they walk into a busy primary care office practice, so everyone feels comfortable."

In addition, TransforMED grooms potential coach candidates within hospital organizations. "We train health system staff to be the coaches, so we can move out and be in the background and support," McGeeney says. Coaches work toward "assessing their ability to function as a team, [as well as] their leadership capabilities at the physician level and staff level," he adds.

Coaching physician practices, especially primary care, and prompting change "is a complex undertaking," the Commonwealth Fund report notes. The country would benefit from a more "systematic approach to the training and deployment of primary care practice coaches."

To improve coaching, curricula and best practices should be shared to convey information about what does and does not work in the field, the study says. In addition, the report recommends establishing centers of excellence and exploring the possibility of community college training programs. "Although rigorous research has demonstrated the value of practice coaching, more research and evaluation is needed to test different models of practice coaching and determine how to deploy practice coaching most efficiently," the study states.

Indeed, the physician coaching process isn't always easy, McGeeney says. "Doctors don't always like it; [they] view it as soft, fluffy stuff. But it's definitely not."