Luis Espinoza, Teresa Chan, MD, Serena Chan

Teresa Chan, MD, is a member of NYC REACH and the Primary Care Information Project Physician Advisory Council (PCIP PAC). Dr. Chan runs a solo private practice, Lower East Side Family Medicine, within one of the Seward Park Cooperative Towers. Her sister, Serena, is the RN and office manager. Luis Espinoza is the medical assistant.  The practice opened in 2013, but Dr. Chan has been serving the Lower East Side community in various non-profit settings since 2000.

This small practice sees about 20 patients a day. They treat teenage, adult, and geriatric patients (the oldest patient is 98 years old). The patients come from diverse backgrounds and many speak only Spanish or Cantonese – which Dr. Chan speaks as well. Holding to Dr. Chan’s belief in the importance of access to good medical care, the practice accepts all kinds of insurance. Patients come from all five boroughs and nearby states including Connecticut and New Jersey. Even patients who spend most of the year in Florida continue to visit Dr. Chan.

We spoke with Dr. Chan about her approach to primary care and her experience with the PAC.

What are solutions to challenges facing NYC providers?

One of the early challenges was that not everyone was on board with using an EHR.  And while there have been significant increases in electronic health records adoption over the past decade, there are still outliers and skepticism abounds. There’s a wide perspective on the utility and role of EHRs in healthcare – what it should be doing is augmenting our ability to help our

patients. Interoperability is also a big deal.  If more electronic data can be shared between providers, that will improve the way we practice and what we can do for our patients. Care needs to be as comprehensive and holistic as possible, and increased interoperability will be one thing that can help get us there. There are so many different EHRs, so getting these systems to talk to each other will be a big deal. I absolutely do believe in health information exchanges, we just need to get it to work seamlessly for both big organizations/hospitals and community physicians.

How do you work with other organizations to improve patient care?

Over the years, NYC REACH has definitely helped us with practice transformation efforts. My practice just attested to Meaningful Use for the fourth year.  Our practice facilitator has been really instrumental in navigating that whole process. I did the HealthyHearts program and Join the BEAT as well. It’s definitely paid off for us. We also are part of Healthix, a qualified entity of the State Health Information Network of New York (SHIN-NY).

Joining CAIPA (the Chinese American Independent Practice Association) has also been greatly beneficial to my practice. They are very proactive about supporting their members and helping us with quality assurance projects, providing us tech/EHR support as well as helping us maximize reimbursement via better contracts with certain insurers.

How important is self-care for providers?

The emotional, spiritual well-being of PCPs is so important. You absolutely have to regenerate and detoxify every day…it’s like the oxygen mask when the plane’s going down.  Like I tell my patients, you have to find a way to manage stress. I do carve out

time for myself and my staff to take breaks and holidays. We have kids. When we close for Christmas break, we close. We’re not going to sacrifice that family time. I don’t ask my staff to hold down the fort while I’m gone; if I’m on vacation, we’re all on vacation. There needs to be that time for family and friends.

I practice the way I feel is in the best manner for my patients and for my team. I’m big on preventive care and on continuity.  I love talking to my patients and letting them talk to me!  I can spend up to an hour on a new patient physical, for example. It’s probably not the best business decision to do that, but if I couldn’t do it this way, I probably would have quit medicine years ago. At the end of the day, I need to be able to find time for me and my family, have a flexible schedule, and decide how many patients I can or need to see in a day to make it all work. Without that flexibility, I can’t provide the kind of care that I believe my patients deserve.  The key is to practice medicine the way that works best for you.

About the PAC

The Primary Care Information Project (PCIP) aims to create services and programs that address common challenges facing NYC primary care providers. In order to understand those challenges and provide solutions, PCIP solicits input from a Physicians Advisory Council (PAC), a diverse group of providers from across the City.

The PAC provides a clinician’s perspective on range of issues in primary care – from managing high blood pressure, to operating under value-based payment arrangements, to adopting electronic health record technology. This valuable insight guides PCIP’s broader efforts to change care management and workflows, strengthen the healthcare system through advocacy and technology, and mitigate the burden of chronic disease.

How did you get involved with the PAC?

When I was a physician at the Henry Street Settlement, I helped to launch their first  EHR system. I reached out to NYC REACH for assistance with that project. I got involved with PCIP back in 2010, when PCIP’s main goal was to get providers set up with EHRs. We talked about helping providers with health information exchange and vendor selection as well as barriers to Meaningful Use and provider outreach. We were a sort of “focus group” for PCIP. I felt from a provider standpoint that it was a great opportunity to be a part of that conversation.

How does connecting with other providers help your practice?

I find our quarterly PAC meetings very helpful, very inspiring – hearing other people’s stories and managing solutions. It’s the amount of help that is offered from the council itself, and the friendships we’ve developed outside of the council. We can ask each other questions about our practices and things like, “What’s your answering service? How are you using the EHR? What templates have you created?” I even completed a course through Small Business Services with other council members that gave us insight into how practices could be run better like any other business.

How important is involving providers in healthcare policy?

Providers want to know where these decisions come from; who’s deciding what we need to do and how we do it to determine if we are good doctors. And that’s part of the problem – [policymakers] can forget about the provider in the process. Of course, as good physicians, we want to have everyone quit tobacco, we want to get our hands around the opioid crisis, and we want to help patients who are depressed.  But at the end of the day, this is not always possible to do without help.  It’s important to canvass the people on the front lines to see what’s preventing them from doing the right thing by their patients. You want to help them be better doctors. It’s nice to hear our city understanding that and wanting to help.

Sometimes it feelslike our needs aren’t really understood or taken into consideration.  We lack resources and have a lot of red tape with insurers. There are many things I wish I could have at my fingertips for my patients… things related to insurance issues, reimbursement issues, mental health access and social work resources.  We can share those “wish lists” with PCIP.

How does the PAC play a role in that?

The PAC gives PCIP a perspective from the trenches that they otherwise wouldn’t have. And it allows primary care providers like me to see what’s on the horizon. For example, if the City is rolling out a tobacco cessation program they may show us the plans ahead of time and get our perspective. They get our opinion on whether we think it will work, what should change, what’s going to be helpful. That’s always part of the problem when you make policy: if you don’t know how things really work in a real practice setting, you can’t know if it’s going to be successfully adopted or welcomed by the providers you are trying to help or target. Having this diverse group on the PAC means that everyone brings a really unique perspective to the table and can increase the chances of a successful endeavor.

PCIP will soon begin the selection process for the 2019 PAC. If you are interested in joining the PAC, e-mail pcip@health.nyc.gov to learn about the application process and membership commitments.